Periodontics: Chapter 11- Shared Decision Making for Periodontal Care

define shared decision making

collaborative process that recognizes the patients right to make decisions about their care after being fully informed about options

shared decision making is the "crux" of patient-centered care (true or false)

true

the patient is recognized as the best expert for judging the value of treatments (true or false)

true

shared decision making is appropriate where?

where there is more than one reasonable option

what is evidence based information?

its a systematic approach to clinical problem solving

what does evidence based information allow?

allows integration of best available research evidence

along with clinical expertise and patient values

a systematic approach summarizes results of available carefully designed by health care studies (true or false)

true

a _______________ decision approach involves significant others from cultural, social and age groups

a SYSTEMATIC decision approach involves significant others from cultural, social and age groups

what are some systematic review characteristics?

-develop a partnership with the patient

-establish patients preferences

-respond to patients ideas and expectations of therapy

-identify best choices for treatment after evaluating research

-allow the patient to reflect on alternative treatment

when patients participate in decision making, they are more likely to follow through (true or false)

true

there are 2 sources of expertise when decision making, what are they?

1. the CLINICIAN is an expert in dental care

2. the PATIENT is an expert on their own life circumstances

the agency for healthcare research and quality have a five-step approach, what is it?

the SHARE approach

seek, help, assess, reach, evaluate

what decision making, we should seek our patients participation, what does that include?

-summarize the periodontal condition and clearly describe to the patient

-ask for their participation in how best to treat them

-include family and caregivers in the discussion

-remind the patient that their input is important

we want to help our patient explore and compare treatment options, how do we do that?

-avoid technical jargon when explaining options

-clearly present benefits of each option

-provide evidence based tools

-evaluate the patients understanding of options

we want to assess our patients values and preferences, how do we do that?

-ask your patient what is important to them and what their concerns are

-encourage dialog on what matters most to the patient

-listen to the patient

-show empathy and interest for any of their life problems

-agree on what is important to your patient

we eventually want to reach a decision with our patient about treatment, how do we do that?

-ask patient if they are ready to decide

-confirm their decision

-assist in removing any barriers to implementing the decision

we want to evaluate our patients decision, how do we do that?

-make plans to review any postponed treatment

-monitor extent of treatment implementation

what are some things we can do as DH to help aid the patients decision?

-use informed resources like written materials, videos

-improve knowledge of options

-elicit better participation in decision making

what is some typical information from patient decision aid?

-description of condition and symptoms

-likely prognosis

-treatment and self-management options

-most frequent complications of the treatment options

the ADHA code of ethics states what?

a patient has a right to informed consent prior to treatment

why is informed consent important?

-a well informed patient is more compliant with treatment recommendations

-patients have a higher trust in health care providers

-patients are more satisfied with their care

-leads to better treatment outcomes

-reduces malpractice risk

the process of communication between a patient and health care provider must be what 3 things?

1. must be voluntary

2. demonstrate they are legally able to provide consent

3. according to "reasonable patient standard"

what does the reasonable patient standard state?

states that a health care provider must disclose all information that a rational patient would want before making a choice to pursue or reject a treatment procedure

who is responsible for the consent of the patient?

the health care provider who performs the treatment

what are some legal claims against health care providers?

-clinician did not perform treatment as decided upon

-clinician did not inform patient properly about risks involved

-poor record keeping

what are the main goals of informed consent?

-provide an individual the opportunity to participate in decisions regarding treatment

-do not guarantee treatment outcomes to the patient

what are some other goals of informed consent?

-diagnosis

-explanation of purpose of treatment

-description of treatment and patients responsibility

-known risks and benefits of proposed treatment

-alternative treatment options

an individual has a legal right to refuse all or part of the proposed treatment (true or false)

true

what are some things to remember with the informed consent document?

-always have the patient sign

-use simple straight forward language

-use a translator when necessary

-provide ample time to answer patient questions

what are some points on legal responsibility of the DH?

-DH are legally responsible for treatment they provide

-without informed consent, patients can claim battery for providing treatment not agreed upon

define negligence/malpractice

is failure to provide sufficient information for the patient to make informed decisions

what are some requirements to demonstrate informed consent?

-periodontal diagnosis in language understood by patient

-thorough discussion of proposed periodontal treatment

-discussion of risks and likelihood of success

-discussion of alternative treatments

-documents that the patient was encouraged to ask questions

format for the consent can be in 2 forms, what are they? describe each

1. WRITTEN:

-need to document refusals too

-once signed, enter into patients permanent record

2. VERBAL:

-still needs to be written in the patient treatment record