Steps of a Shared Decision-Making Conversation
Steps of a shared decision-making conversation in use
The examples below illustrate how these steps might be used with preference-sensitive conditions.
SDM Steps and Diabetes
Phyllis is a 55-year old patient you care for with Type 2 Diabetes and her most recent A1C is 8.7. She takes Metformin and Glipizide faithfully at a maximal dose. A change in regimen is needed. Should you add Lantus or an additional oral agent? Is this purely a decision based on an algorithm? How does the patient share in this decision? Here is an example of how the SDM conversations steps might be used:
Involve your patient
“Having a diagnosis of diabetes and making treatment decisions can be overwhelming. We’ll work
together to develop a plan that works for you.”
Assess knowledge and decision-making
“Tell me, what benefit is there to you in better diabetes control?” This is an opportunity to know
where to begin to provide the “why” to change.
Present all treatment options, risk and benefits
Review options to improve diabetes control. Review costs (financial and burdens of treatment), side effects (risks), benefits of options.
Identify values and preferences
“Now that you understand the facts, what options seem best for you?”
Mutually agree on a plan of care and document it
“Here is what I hear from you. Based on what you think will work for you, let’s plan the next steps.”
Validate understanding
Use teach-back to assess patient’s understanding.
SDM Steps and Prostate Cancer
Jim is a 75 year old man who has recently been diagnosed with early stage prostate cancer. He is healthy and lives an active lifestyle. He is wondering about his treatment options. His wife has heard about
potential side effects of treatment. She is worried about how these would effect him.
Involve your patient
“There are many ways to approach your cancer. We will work with you to explore these options and help you understand which will be best for you.”
Assess knowledge and decision-making
“What do you know about these treatments? How concerned are you about the potential for side effects of treatment? Present all treatment options, risk and benefits Review all the options with Jim including the potential for “active surveillance”. Discuss his expected life expectancy and the potential benefits and risks of each option.
Identify values and preferences
“Now that you understand the facts, what options seem best for you?” Mutually agree on a plan of care and document it “Here is what I hear from you. Based on what you think will work for you, let’s plan the next steps.”
Validate understanding
Use teach-back to assess patient’s understanding
SDM Steps and Colon Cancer Screening
Frank is a 50 year old healthy man. He recently saw a billboard about colon cancer screening. He is very busy with his work and would like to know more about this but does not want to take too much time away from work to deal with it.
Involve your patient
“You have more than one option when it comes to screening for colon cancer. We can discuss which
one will be easiest for you.”
Assess knowledge and decision-making
“What have you heard about the options for screening? How much time would you be able to spend?
Would an option that you did at home work better for you?”
Present all treatment options, risk and benefits Review all available options including colonoscopy which would take more time but would be done only every 10 years and FIT testing which the patient could do at home and would not cause him to miss work.
Identify values and preferences
“Now that you understand the facts, what options seem best for you?”
Mutually agree on a plan of care and document it
“Here is what I hear from you. Based on what you think will work for you, let’s plan the next steps.”
Validate understanding
Use teach-back to assess patient’s understanding.