How can we share treatment decisions?

pot_of_gold_rainbow (107x160)I guess part of me wants to start this blog with “Never knowingly topical”, but in the UK an as yet unclear explosion of media interest has been generated around decision making and a child with a brain tumour.

Those who want to can find out more via reputable news sites – as a staunch middle-class Northerner, I’ll just link to the BBC from the start of the very long story.

Where much of this very difficult story seems to be around consent, and best interests, I’d like to take a more routine approach to the issue. How do we, in everyday care, make sure that our interactions with children, young people and their families share the decisions as much as possible?

There’s a nice systematic review that looks at the challenges in making really evidence informed, well balanced, decisions. In adults, there are challenges:

  • Patients feel they can’t participate in shared decision making

  • Power imbalances are a key barrier even with knowledgable patients

To overcome these barriers there need to be change:

  • Patients need to know their input is wanted and that discussions won’t affect the quality of care

  • Attitudes – of both patients and clinicians – need to change.

Now take these issues and multiply them by shrinking the patient. Then add to this the difficulties in communicating information well and understandably – a systematic review of good quality studies looking at how to communicate risks and benefits found a scant amount of work and some conflict within it. Yet we can find more and more data that by empowering patients (in adult life) we can get better use of healthcare resources and as good, if not better, clinical outcomes.

So, the challenge we face is not ‘Can’ but ‘How can’ we develop our attitudes and skills to promote shared decision making, improve engagement in care, make resource utilisation more efficient and generally Spread Goodness?

Well, I’d suggest we start by taking a good look at where shared decisions work well, use meaningful qualitative techniques, and develop aids and communication approaches that promote joint decisions. But does anyone have other thoughts?

– Archi

(ps – Barbie’s magic wand is locked away and the play lady says we can’t use it for the above task.)

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