1 saudi diploma in family medicine center of post graduate studies in family medicine principles of...
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Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine
Principles of Family MedicinePrinciples of Family Medicine
Shared Decision Making and Shared Decision Making and
Patient EmpowermentPatient Empowerment
Dr. Zekeriya Aktü[email protected]
www.aile.net
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Our experiences as patients: did you ever feel powerless?
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Objectives
• At the end of this session the participants will be able to;– discuss the definition of patient empowerment– discuss the status of patient empowerment in FP– explain the need for patient empowerment– explain the power/relationship graph– discuss the reasons of powerless patients– explain how to empower patients
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What is it?
• an individual being an active member of his/her disease management team
Laura E. Santurri. Patient Empowerment: Improving the Outcomes of Chronic Diseases Through Self-Management Education. http://www.case.edu/med/epidbio/mphp439/Patient_Empowerment.htm
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The idea behind
• Patients cannot be forced to follow a lifestyle dictated by others.
• Preventive medicine requires patient empowerment for it to be effective.
• Patients as consumers have the right to make their own choices and the ability to act on them
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Why Patient Empowerment?
• Patients and physicians committed to joint decision-making
• Patients research own health conditions• Patients today expect physicians to be team
leaders and to provide clinical and educational support
• Physicians are the lead source of information, the most trusted source, and the source most likely to catalyze positive behavior change
Magee, Relationship-Based Health Care in the US, UK, Canada, Germany, S. Africa, and Japan, 2003
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• Only 9% of consultations with surgeons and primary care physicians meet full criteria for informed decision making. Braddock JAMA 1999
• Distinguishing elements of shared decision making occurred in 0-11% of audio taped patient interviews with general practitioners. Elwyn 2001
• “.. Checking of understanding, and the involving of patients in decision making .. are rarely demonstrated” [in video taped consultations submitted for MRCGP examination]. Campion BMJ 2002
Why Patient Empowerment?
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“People whose lives are affected by a decision must be a part of the process of arriving at that decision.”
–John Naisbitt, Megatrends
Why Patient Empowerment?
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Power
Relationship
PartnershipTransaction
Keep
Share
The Power/Relationship Graph
http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck
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Impose Dictate
Compromise Common ground
Problem Solving
Power
Relationship
PartnershipTransaction
Keep
Share
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USA Japan
China
Sweden
UK
Italy
Middle east
France
Russia
Germany
Countries
Power
Relationship
PartnershipTransaction
Keep
Share
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How is it with you?
No Partially (sometimes) Yes
0 1 2
Total score SDM
0 None
1-12 Low
13-24 Moderate
25-32 High
* Use this scoring table to calculate your own total SDM scores according to the distributed questionnaire.
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• Education• Professional status/authority• Knowledge• Skills• Expertise• Experience• On familiar territory• GATEKEEPER TO HEALTHCARE SYSTEM
Why is the concentration of power in this relationship with physician?
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• Patient is sick, weak, vulnerable, not feeling fully oneself…
• Patient may be afraid
• Patient in a state of dependency
• Lack of medical knowledge
• Lack of knowledge on the “system” and how it works
• Unfamiliar environment
Why is the concentration of power in this relationship with physician?
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Benefits of Patient Empowerment
• Learning from our patients
• Taking a proactive role• Providing a support & information service
to our patients and staff• Complaint Resolution• Negotiation & Mediation• Building trust
16Follow-up
Management / treatment
Presenting concern“patient’s story”
History and physical exam
Hypothesis
Identified problem or diagnosis
Identify choices
Review pt’s preference for information
Present evidence
Respond to pt’s ideas, concerns and expectations
re: management
Assess partnership (review previous steps)
DOCTOR - PATIENT COMMUNICATION
Establish pt’s role in decision making
Agree on an action plan
Negotiate a decision
Model forModel forClinical Problem Solving & ISDMClinical Problem Solving & ISDM
Step 1 Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
/ 2017
Feeling vulnerable
Not involved No dialogue
Disempowered
No Partnership
No Voice in the System
/ 2018
Empowerment allows our relationships to grow in strength