Many assigned with implementing SDM report that their colleagues believe they already provide SDM in their practice. As we covered in the myths and misconceptions blog, there can be an assumption that SDM means getting the patients to agree to a particular clinical recommendation – and not reflecting that ‘sharing’ actually means the process of providing unbiased information about harms, benefits and options for the patient to make an informed decision that is right for the patient’s preferences and situation.
How can you know the extent to which SDM is being practiced at your health service? How can you help people know if they practice SDM with real time feedback? There are a few data sources and indicators that can help you understand if SDM is being used (and how effectively) at your service.
- How informed are patients (and/or their family) about the harms and benefits related to healthcare options they are considering?
- How confident are patients (and/or their family) to be involved in healthcare decisions?
- Do patients (and/or their family) experience decisional regret?
- Is more than one option for care/treatment being presented to the patient (and/or their family)?
- Are the patient’s values and preferences discussed as part of the decision making process?
Knowing what data is needed is the first step. Being able to collect and access the data can actually be straight forward. In most cases there are two options available to you – to use existing data or collect your own.
1. Use existing data
List the tools, processes, questionnaires or surveys your service currently has in place to help understand patient experience. In Victoria we are fortunate to have the Victorian Health Experience Survey (VHES) that includes questions about level of involvement in decisions about treatment and care or discharge and explanation of risks/benefits. It also includes a question to identify if patients were asked what is important to them in managing their condition or symptoms.
You could use these questions from the VHES:
- Were you involved (as much as you wanted to be) in decisions about your treatment or care plan?
- Did you feel you were involved in decisions about your discharge from hospital?
- Before the treatment did a health professional explain any risks and/or benefits in a way you could understand?
- Did a healthcare professional ask you what was important to you in managing your condition or symptoms?
- If you had any worries or fears about your condition or treatment, did the doctor/health professional discuss them with you?
What the VHES doesn’t do, is explore if patients were given two or more options to choose from so you may need to think about adding a question to your own service level data collection tools to help measure this critical component of SDM.
If the sample size for your health service was sufficient, then the quality and safety team for your service should be able to drill down to see results at even a program/ward level.
Similar questions are asked in patient experience surveys for other Australian states and territories. For example, the Patient Surveys in NSW ask patients to respond to the statement “I was involved as much as I wanted in making decisions about my treatment and care” and The South Australia Consumer Experience Surveillance System collects data on the patient’s role in decision making (2019 SA Consumer Experience Report).
You may also have other patient experience surveys, exit questionnaires or complaints data at a service level that ask relevant questions and can help determine how SDM may be implemented at your service.
2. Create your own baseline
Where possible, it is good to try to utilise existing data collection systems that your service uses. If there is an exit survey or patient experience interview/questionnaire that takes place, try to include some relevant questions into those tools. For example, you could take the VHES questions listed above, and possibly add in a question about whether two or more options were discussed.
Another idea is to use a data collection tool in clinical practice (documented in the health record) or surveys, for example the 4-item SURE Test, to screen for decisional conflict experienced by patients.. If the test produces a low result (0/4), it indicates the patient needs more support to address feeling uninformed, unclear values, and inadequate support as they have a high level of decisional conflict. If they score 4/4, they are comfortable with the decision made. You could identify a time and target group of patients faced with a particular decision.
Once you have some data available, think about how the results can help tailor your SDM educational work, systems improvement, communications training, health promotion or decision aid development.
Questions to consider
- What data sets do you have access to that can help you understand patients’ decisional need within your services?
- How can you ensure the right questions are being asked to collect the data you need?
- What other questions or measures do you think would help to understand patient/family decisional conflict and comfort with making decisions?
Links and references
- The SURE Test © 2008 was created by O’Connor & Légaré. It is a validated data collection tool to help measure decisional conflict in patients/family. It is used in section 3 of the Ottawa Personal Decision Guide
- Victorian Health Experience Survey results
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