| Goal |
Implementation Strategies & Resources |
| Elicit patient preferences according to the individual situation. |
Keep in Mind:
- Less complex situations require abbreviated decision-making;
- More complex situations with multiple options may require several steps.
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| Recognize when decisions are "preference-sensitive" for the patient. |
- Know which factors are most important to each patient;
- Examples of preference-sensitive decisions:
- therapy that may improve one condition but make another worse;
- therapy that may confer long-term benefits but cause short-term harm;
- multiple medications with benefits and harms that must be balanced.
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| Ensure that patients are adequately informed about benefits and harms of treatment options. |
Key considerations:
- Consider effects of treatments and interventions, particularly side effects, which may be seen as important outcomes for the patient.
- Provide numerical likelihoods of specific outcomes if available:
- include probabilities of the outcome occurring or not occurring;
- present absolute rather than relative risk;
- use visual aids.
- Assess patient understanding of the information, e.g., using a "teach back" technique.
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| Elicit patient preferences only after the individual is sufficiently informed, using appropriate tools. |
Decision aids are available, but may not be able to accommodate different comorbidity and risk factor profiles;
Resources:
- Decision analysis: a "decision tree" can facilitate decisions by identifying and quantifying all potential treatment outcomes;
- Conjoint analysis: assigns scores to characteristics of treatment outcomes to assess which are most important to individual patients;
- Patient prioritization: The patient chooses among sets of universal health outcomes to identify those most important to the individual, e.g., living as long as possible, being pain-free, maintaining function, and then chooses treatment options based on most desired outcomes.
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| Accommodate the individual's decision-making style, while acknowledging that all patients want their opinions to guide choices. |
Decision styles include:
- Patient prefers to make decisions;
- Patient prefers that healthcare provider decides;
- Shared decision-making preferred;
- Patient prefers involvement of family, friends, caregivers in decision-making;
Keep in Mind:
- Patients with cognitive impairment may rely on significant others as surrogates to act with healthcare providers to make decisions for them.
- Preferences may change over time, and should be re-examined, especially with a change in health status.
- Patients cannot demand any and all treatments if these options do not have a reasonable expectation of some benefit.
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