LEARNING GUIDE:  VALUES AND ETHICS (PATIENT-CENTERED CARE AND SHARED DECISION-MAKING)

OVERVIEW

This lesson offers students an opportunity to review and reflect on the topics of patient-centered care and as well as shared decision-making with patients and/or within the interprofessional team.

OBJECTIVES

For this lesson you will:

1. Examine interprofessional teams in terms of their decision-making; consider the similarities and differences, along with barriers and facilitators (found in documents such as the Code of Ethics for each discipline).
2. Identify factors that empower patient involvement in decision-making.
3. Explain how the interprofessional team uses a shared decision-making model to support the patient’s preference, values, and beliefs to achieve best healthcare outcomes.

COMPETENCIES

DEFINITIONS

Decision-making – is the process of choosing between alternatives, which may include doing nothing (Ottawa Decision Support Tutorial, 2022).

Interprofessional values and ethics – “Interprofessional values and related ethics are an important, new part of crafting professional identity, one that is both professional and interprofessional in nature.  These values and ethics are patient centered with a community/population orientation, grounded in a sense of shared purpose to support the common good in health care, reflect a shared commitment to creating safer, more efficient, and more effective systems of care” (IPEC, 2011, p.17).

Patient decision aids – While some critics of shared decision-making maintain that patients are not able or willing to make their own health care decisions, there is considerable evidence that patients want more information and greater involvement in decision-making in partnership with their doctors.  The innovation of shared decision-making is the use of evidence-based tools, known as patient decision aids, to inform patients and help them set their own goals and clarify their values (AHRQ, 2013)

Patient-centered care (PCC) – “The experience (to the extent the informed, individual patient desired) of transparency, individualization, recognition/respect, dignity, in all matters, without exception, related to one’s person, circumstances, and relationships in healthcare” (Berwick, 2009, p.w 560).

Person-focused care [Person-centered care] – “is based on accumulated knowledge of people, which provides the basis for better recognition of health problems and needs over time and facilitates appropriate care for these needs in the context of other needs. That is, it specifically focuses on the whole person” (Starfield, 2011).

Shared decision-making (SDM) – is a model of patient-centered care that enables and encourages people to play a role in the medical decisions that affect their health (AHRQ, 2013)

LEARNING ACTIVITIES

• The following sources with study guides have been curated for student learning.
• For application and demonstration of learning, lab exercises can be found in the second half of this online education resource, Lab Exercises

WATCH: Don Berwick – What Patient Centered Care Really Means

Study Guide:  Berwick is recognized and credited with defining patient-centered care.  His work, reflected in the creation and evolution of the Institute for Healthcare Improvement (IHI), originates from a professional commitment to patient safety and listening to patients.  This video is a short video that captures the patient voice.

REFERENCE:  Berwick.  (2009).  Don Berwick – What Patient Centered Care Really Means.  [Video].  YouTube.

READ: Is Patient-Centered Care the Same As Person-Focused Care [Person-Centered Care]?

Study Guide:  Starfield discusses the evolution of terminology from patient-centered care to patient-focused care; that the WHO and USA now name as person-centered care.  Review the differences in these two terms and/or methods of delivering patient care in Table 1. on p. 95.

REFERENCE:  Starfield B. (2011).  Is patient-centered care the same as person-focused care? The Permanente Journal, 15(2):63-9.

READ:  Shared decision making and patient centered care

Study Guide:  Skelly, Hall & Risher offer the link between shared decision-making and patient-centered care and its origin from nursing that honorspatient autonomy.

REFERENCE:  Skelly, C. L., Hall, C. A., & Risher, C. R.  (2020).  Shared decision making and patient centered care.

EXAMINE:  The SHARE Approach:  Essential Steps of Shared Decision Making

Study Guide:  This is a visual model of patient-centered care and shared decision-making and how the interprofessional (IP) team provides individualized care.

REFERENCE:  Agency for Healthcare Research & Quality (AHRQ). (2014). The SHARE Approach:  Essential Steps of Shared Decision Making.  Retrieved from www.ahrq.gov/shareddecisionmaking. (AHRQ Pub. No. 14-0026-2-EF).

REVIEW:  Strategy 61:  Shared Decision-making

Study Guide:  This is a short online module from AHRQ that explains shared decision-making as well as introduces the SHARE Approach Model.  Read all 4 sections:  6.1.1, 6.1.2, 6.1.3, and 6.1.4.

REFERENCE:  Agency for Healthcare Research and Quality. (2013, June).  Strategy 61:  Shared Decision-making.

WATCH:  SHARE Approach Video

Study Guide:  This is a 10-minute video that demonstrates a patient-physician interaction using the SHARE Approach.  Although the demo is that of a patient and physician, this strategy is recommended to be used by all healthcare professions when providing care to patients/clients.

REFERENCE:  Agency for Healthcare Research and Quality (2019, November).  SHARE Approach Video.

LESSON REFERENCES

Berwick, D. M. (2009). What ‘patient-centered’ should mean: Confessions of an extremist. Health Affairs, 28, (3/4), ProQuest, W555

Interprofessional Education Collaborative Expert Panel.  (2011). Core competencies for interprofessional practice:  Report of an expert panel.  Washington, D.C.:  Interprofessional Education Collaborative

Ottawa Hospital Research Institute.  (2022, October 18).  Patient Decision Aids.  Retrieved November 12, 2022, from https://decisionaid.ohri.ca/