{"id":1347,"date":"2017-07-26T12:31:30","date_gmt":"2017-07-26T11:31:30","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=1347"},"modified":"2017-10-25T12:06:56","modified_gmt":"2017-10-25T11:06:56","slug":"shared-decision-making","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2017\/07\/26\/shared-decision-making\/","title":{"rendered":"Shared decision making"},"content":{"rendered":"<p>So the model of EBM that we espouse is one grounded in the patient &#8216;dilemma&#8217; being the start and end point of the process. You&#8217;ll recall it&#8217;s a patient&#8217;s situation that triggers the <a href=\"https:\/\/blogs.bmj.com\/adc\/2009\/12\/19\/finding-the-question\/\">asking of a PICO question<\/a>, and particularly <a href=\"https:\/\/blogs.bmj.com\/adc\/2014\/08\/31\/which-o-for-pico\/\">the selection of patient-oriented outcomes <\/a>are vitally important. The <a href=\"https:\/\/blogs.bmj.com\/adc\/2015\/03\/20\/when-is-enough-enough\/\">acquisition <\/a>and<a href=\"https:\/\/blogs.bmj.com\/adc\/2010\/03\/07\/fast-appraisals\/\"> appraisal of studies<\/a> that follow link to this, then <a href=\"https:\/\/blogs.bmj.com\/adc\/2015\/09\/01\/whose-values\/\">applying the results of your deliberations<\/a> needs to bring those thoughts back to the patient and discussing where to go\u00a0with it.<\/p>\n<p><!--more--><\/p>\n<p>That discussion of where to go is the core of shared decision making.<\/p>\n<p>My experience of shared decision making has evolved over my years of working in paediatric oncology. Most often,\u00a0I&#8217;ve had conversations which are most shared and least guided when we&#8217;re talking about symptom-relieving approaches where a variety of near-equally effective options are\u00a0open. (Next most often it&#8217;s in the situation of relapsing disease where a wide range of uncertainty in many dimensions appears.) For a massive range of not-yet-senior clinicians, the realms of non-life-saving interventions are where I would suggest you take a brave step into the world of shared decision making.<\/p>\n<p>Really.<\/p>\n<p>Actually.<\/p>\n<p>Not EBM as a satisfying but ultimately brain stretching but pointless exercise but a fundamental way of practicing medicine. Why not take it up with the next young person you meet who doesn&#8217;t like their laxative, or family considering their new baby&#8217;s soft and uncannulated skin?<\/p>\n<p>&#8211; Archi<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>So the model of EBM that we espouse is one grounded in the patient &#8216;dilemma&#8217; being the start and end point of the process. You&#8217;ll recall it&#8217;s a patient&#8217;s situation that triggers the asking of a PICO question, and particularly the selection of patient-oriented outcomes are vitally important. The acquisition and appraisal of studies that [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2017\/07\/26\/shared-decision-making\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79],"tags":[],"class_list":["post-1347","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Shared decision making - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2017\/07\/26\/shared-decision-making\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Shared decision making - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"So the model of EBM that we espouse is one grounded in the patient &#8216;dilemma&#8217; being the start and end point of the process. 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