Shared Decision-making for PTSD

Juliette Harik, PhD
PTSD Research Quarterly (2018) Volume 29 (1)

Here is an excerpt:

Although several different shared decision-making models exist (for a review see Lin & Fagerlin, 2014), one useful approach conceptualizes shared decision-making as consisting of three phases
(Elwyn et al., 2012): choice talk, option talk, and decision talk. Choice talk involves communicating
to patients that there is a decision to make and that they can be involved in this decision to the extent
that they are comfortable. Option talk consists of sharing accurate and comprehensive information
about treatment options. Ideally, this involves the use of a decision aid, which is an educational tool
such as a website, brochure, or video designed to help patients understand and compare various
options (for a review, see Stacey et al., 2017). The third and final step, decision talk, consists of an
exploration of the patient’s preferences and what matters most to him or her. The process of shared
decision-making is intended to help the patient develop informed preferences, and ultimately arrive
at the decision that is best for him or her. Importantly, patients with the same clinical condition may arrive at very different treatment decisions on the basis of unique values and preferences.

Shared decision-making has been evaluated most often among patients facing care decisions for chronic medical conditions, especially cancer. In medical patients, shared decision-making has been linked with greater confidence in the treatment decision, improved satisfaction with decision-making and with treatment, greater self-efficacy, and increased trust in the provider (Joosten et al., 2008; Shay & Lafata, 2015). In mental health, shared decision-making has been most often evaluated in the context of depression, yielding mixed results on both satisfaction and treatment outcomes (Duncan, Best, & Hagen, 2010). Fewer studies have evaluated the effectiveness of shared decision-making for other mental health conditions such as PTSD.

The information is here.

Overcoming patient reluctance to be involved in medical decision making

J.S. Blumenthal-Barby
Patient Education and Counseling
January 2017, Volume 100, Issue 1, Pages 14–17

Abstract

Objective

To review the barriers to patient engagement and techniques to increase patients’ engagement in their medical decision-making and care.

Discussion

Barriers exist to patient involvement in their decision-making and care. Individual barriers include education, language, and culture/attitudes (e.g., deference to physicians). Contextual barriers include time (lack of) and timing (e.g., lag between test results being available and patient encounter). Clinicians should gauge patients’ interest in being involved and their level of current knowledge about their condition and options. Framing information in multiple ways and modalities can enhance understanding, which can empower patients to become more engaged. Tools such as decision aids or audio recording of conversations can help patients remember important information, a requirement for meaningful engagement. Clinicians and researchers should work to create social norms and prompts around patients asking questions and expressing their values. Telehealth and electronic platforms are promising modalities for allowing patients to ask questions on in a non-intimidating atmosphere.

Conclusion

Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes.

The article is here.

Episode 14: Ethics and Quality Enhancement Strategies

In Episode 14, John welcomes Dr. Sam Knapp back to the podcast.  Sam was fresh off his Lifetime Achievement Award in Ethics Education from the American Psychological Association.  After John's first attempt at listener mail, the topic moves toward ethics education and ways to contemplate positive ethics.  Rather than looking at remedial ethics or the ethical floor, John and Sam give examples about striving for the ethical ceiling.  The focus on quality enhancement strategies grew out of risk management strategies.  From a quality enhancement perspective, Sam and John give several examples of what may trigger the need for quality enhancement strategies.  They also review four quality enhancement strategies: 1) consultation, 2) empowered collaboration, 3) documentation, and 4) redundant protections.  Sam and John also talk about psychologists' emotional reactions to patients.

At the end of this podcast, the listener will be able to:

1. Outline three quality enhancement strategies,
2. Describe how to prepare for a helpful consultation, and,
3. List the reasons why redundant protections are helpful in clinical practice.

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Resources for this podcast

Ethical Issues With Patients at a High Risk for Treatment Failure 

Samuel J. Knapp and John Gavazzi

Can Checklists Help to Reduce Treatment Failure?

Sam Knapp and John Gavazzi

Quality Enhancement Strategies - PowerPoint

John Gavazzi, PsyD ABPP

Episode 8: The Dark Side of Ethics - False Risk Management Strategies 

Therapists' Anger, Hate, Fear, and Sexual Feelings: National Survey of Therapist Responses, Client Characteristics, Critical Events, Formal Complaints, and Training

Ken Pope and Barbara G. Tabachnick