SHARE Approach Workshop Curriculum
Slide 1. Cover Slide
Slide 2. Module 4 Putting Shared Decision Making Into Practice
Slide 3. Module 4—Purpose
Slide 4. Module 4—Learning objectives
Slide 5. Tool 8—Putting Shared Decision Making into Practice: A User's Guide for Clinical Teams
Slide 6. Key activities for implementing shared decision making in practice
Slide 7. Key Activity 1: Getting Leadership Buy-in
Slide 8. Leadership buy-in is important
Slide 9. Leadership buy-in?
Slide 10. Tool 9—Achieving Patient-Centered Care with Shared Decision Making:A Brief for Administrators and Practice Leaders
Slide 11. The Administrators Brief
Slide 12. The Administrators Brief
Slide 13. Better care1-2
Slide 14. Better health2-6
Slide 15. Lowers cost5-7
Slide 16: Shared decision making helps you meet national certification requirements
Slide 17. Once you are back on the job
Slide 18. Tool 8—Putting Shared Decision Making into Practice: A User's Guide for Clinical Teams
Slide 19. Key Activity 2Form an Implementation Team
Slide 20. Develop implementation team
Slide 21. Develop implementation team
Slide 22. Develop implementation team
Slide 23. Key Activity 3—Select an Approach Tailored to Your Practice
Slide 24. Start with one or two conditions
Slide 25. Decide who does what
Slide 26. Use supporting materials
Slide 27. Decide when to introduce decision aids
Slide 28. Address concerns about timeconstraints
Slide 29. Key Activity 4—Provide Ongoing Training and Ongoing Support
Slide 30. Provide training
Slide 31. Provide regular feedback and ongoing support
Slide 32. Provide regular feedback and ongoing support
Slide 33. Discussion
Slide 34. Key Activity 5—Start Small, Then Take To Scale
Slide 35. Start small, and take to scale
Slide 36. Key Activity 6—Create A Physical Setting For Shared Decision Making
Slide 37. Create a physical setting for shared decision making
Slide 38. Create a physical setting for shared decision making
Slide 39. Key Activity 7—Create A Library of Evidence-Based Resources and Patient Decision Aids
Slide 40. Locate evidence-based resources
Slide 41. Key Activity 8—Streamline Work Processes
Slide 42. Streamline shared decision-making work processes
Slide 43. Key Activity 9—Conduct Ongoing Evaluation
Slide 44. Conduct ongoing evaluation
Slide 45. Conduct ongoing evaluation
Slide 46. Questions and Answers
Slide 47. Developing an Action Plan
Slide 48. Instructions
Slide 49. Debrief
Slide 50. Review of Key Takeaways
Slide 51. Key Takeaways
Slide 52. Key Takeaways
Slide 53. Citations
Slide 54. Citations
The SHARE ApproachEssential Steps of Shared Decision Making.
Putting Shared Decision MakingInto Practice.
To introduce key activities and strategies to consider as part of incorporating shared decision making into practice at your organization, including obtaining leadership support.
At the conclusion of this activity, the participant will be able to:
- Explain why it is important to engage the entire medical practice.
- Explain roles that different team members can play in implementing shared decision making in practice.
- Describe the steps required for implementing shared decision making and the use of patient-centered outcomes research (PCOR).
- Identify current incentives for adopting shared decision making and PCOR decision materials in practice.
Putting Shared Decision Making into Practice: A User's Guide for Clinical Teams.
- Get leadership buy-in.
- Develop an implementation team.
- Select an approach that is tailored to your practice.
- Provide training and ongoing support to all staff.
- Start small, then take it to scale.
- Create a physical setting for shared decision making.
- Create a library of evidence-based educational resources and decision aids.
- Streamline shared decision-making work processes into day-to-day operations.
- Evaluate the ongoing implementation of shared decision making.
Implementing shared decision making requires a coordinated plan.
Refer to page 3 of Tool 8.
Getting Leadership Buy-in.
- Shared decision making may require changes in staff assignments, resource allocations, and workflow.
- These kinds of changes need to be authorized by your organization's leaders.
Who already has leadership buy-in?
- Asked to come to training by leadership.
Who had to do the persuading?
Achieving Patient-Centered Care with Shared Decision Making:A Brief for Administrators and Practice Leaders.
- Briefly outlines what implementing PCOR resources via shared decision making involves, and the benefits of doing so.
Shared decision making is aligned with the three aims of the U.S. Department of Health and Human Services' National Quality Strategy—better care, better health, and lower costs.
- Share this tool with your workshop participants to highlight the benefits for implementing shared decision making at your organization.
Slide 13: Better care1-2
Shared decision making improves patients' experience of care.
Patients find they:
- Improve their knowledge of the options.
- Have more accurate expectations of possible benefits and harms.
- Have less decisional conflict.
- Reach choices that are more consistent with their values.
- Participate more in decision making.
Complete references are listed on the last two slides.
Slide 14: Better health2-6
Patients engaged in shared decision making show:
- Improved health outcomes (e.g., improved quality of life, better symptom control, improved self-management, and reduced symptoms of depression).
- Improved treatment adherence.
Slide 15: Lowers cost5-7
Shared decision making can lower costs.
- Patients are more likely to select conservative treatment options over elective invasive procedures when they understand the potential benefits and harms.5, 6
- Shared decision making for 11 preference-sensitive conditions/procedures is estimated to result in national cost savings of $9.2 billion over 10 years.7
Refer to page 3, Tool 9 for list of conditions/procedures.
Preference-sensitive conditions are those in which legitimate treatment options exist, each with its own trade-offs.
Looking to become recognized or certified as a patient-centered medical home (PCMH) or accountable care organization (ACO)?
- Incorporating shared decision making into your clinical practice can help you meet standards established by the National Committee for Quality Assurance, Accreditation for Ambulatory Health Care, and the Joint Commission (refer to page 5, Tool 9).
Who already works in a PCMH or ACO?
- Share the Administrator's Brief with your leadership and staff to sustain interest.
- Remind that it only takes one or two people to champion the cause.
Do you know anyone who could be a good champion? Perhaps yourself?
Putting Shared Decision Making into Practice:A User's Guide for Clinical Teams.
Form an Implementation Team.
Refer to page 4, Tool 8.
- An in-house team can design an appropriate approach for your setting.
- Team members may include:
- Clinical providers.
- Health educators.
- Front desk staff.
Who else would you invite to be on this team?
- Responsibilities include:
- Developing an implementation plan.
- Reviewing patient support materials.
- Conducting training and ongoing coaching.
- Monitoring ongoingadoption.
Select an Approach Tailored to Your Practice.
Refer to page 5, Tool 8.
- Identify one or two high-priority health conditions in which you will implement shared decision making.
- What criteria will you use?
- Add more conditions once everyone is familiar with shared decision making.
- Planning team designates roles and responsibilities for each shared decision-making team member.
Who will be involved and what will their roles be?
- Identify evidence-based patient decision materials to support the shared decision-making process for selected health conditions.
- AHRQ offers free and easy-to-navigate decision aids and consumer research summaries.
Refer to pages 10-15 of Tool 8 for listing of resources.
- Choose optimal point in decision-making process to introduce decision aids.
- Time of diagnosis? Or afterward?
- Part of the office visit? Or mailed in advance?
- Do staff members review with patient, or does the patient call with questions?
- Set a standard operating procedure.
Refer to page 5, Tool 8 for examples.
- Be proactive. Discuss time concerns during training and during implementation.
- Reassure staff that shared decision making should not take more time than what they were used to doing.
Studies have found that clinicians can implement shared decision making without increasing the length of the consultation time.8-10
Recall the SHARE Approach video? Share it with your colleagues.
Provide Ongoing Training and Ongoing Support
Refer to page 5, Tool 8.
- Train all relevant staff in shared decision making.
- Model in-house training on SHARE Approach Workshop (module by module, during staff meetings, during lunch hours, etc.).
- Use the Shared Decision Making Toolkit on the AHRQ Web site to access materials.www.ahrq.gov/shareddecisionmaking.
You can learn more about training others on the SHARE Approach AHRQ's Trainer Module.
- Provide ongoing training, feedback, and coaching. One training is not enough to institutionalize shared decision making.
- Some ongoing training strategies might include:
- Video/audio recording patient/provider interactions while practicing shared decision making.
- Shadowing trainees and providing feedback.
- Use available AHRQ training support, including a learning network and Web conferences.
Learn more about ongoing support offered by AHRQ at www.ahrq.gov/shareddecisionmaking.
What are your thoughts about training others when you return home?
What challenges do you foresee?
Are there creative ways to address these challenges?
Start Small, Then Take To Scale.
Refer to page 7, Tool 8.
- Pilot shared decision making in one department or for one or two health conditions.
- Gather needed resources.
- Test your approach to see what works and what does not.
- Revise approach, as needed.
- Expand to additional departments or health conditions.
Where do you think the best place to start is in your own practice?
Create A Physical Setting For Shared Decision Making.
Refer to page 7, Tool 8.
- Address logistical issues in your plan (e.g., space to house decision aids and equipment).
- If your practice decides to have patients review decision aids onsite, create a comfortable space for them to use.
- Consider using a DVD player and screen, laptop computer, or tablet for patients toreview audiovisual aids.
Create A Library of Evidence-Based Resources and Patient Decision Aids.
Refer to page 7, Tool 8.
- There are many free resources available, including AHRQ's Effective Health Care Program materials.
Refer to pages 10-12 in Tool 8 for a list of Free decision support resources.
Streamline Work Processes.
Refer to page 8, Tool 8.
- Use existing workflow processes, such as electronic health records, to integrate decision aids.
Conduct Ongoing Evaluation.
Refer to page 9, Tool 8.
- Evaluation helps you fine-tune the use of shared decision making in your practice.
- Consider formal evaluation using validated instruments.
Refer to page 14, Tool 8 for a list of evaluation resources and tools.
- Informal evaluation → formal evaluation
- Gather feedback on what works and what needs improvement.
- Share success stories (e.g.,meetings, email,newsletters).
Questions and Answers.
Developing an Action Plan.
- Work in teams to develop an action plan for implementing shared decision making in your organization for 20 minutes.
- Choose a reporter.
- Report to entire group on key issues you encountered in developing an action plan.
Review of Key Takeaways.
- Get leadership buy-in if you don't already have it. Share Tool 9 with your colleagues and senior leaders so they understand the benefits of shared decision making.
- Your implementation team can include a variety of members of your organization (e.g., clinical staff, administrators, front desk staff, etc.). Be sure to have one or two champions.
- Implementation of shared decision making involves a number of activities. Start by developing an implementation plan. Who does what, when, and how?
- Choose an approach that works for your setting.
- Start small and then scale as you get experience.
- Evaluate your efforts and share feedback with the entire team.
Remember that change takes time.
- Stacey D, Légaré F, Col NF, et. al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014 Jan 28; 1:CD001431. PubMed PMID: 24470076 (2014 Systematic Review; 113 studies; 34,444 participants).
- O'Connor A.M., Llewellyn-Thomas, H.A., Flood, A.B. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood) 2004;Suppl Variation:VAR63-72. PMID: 15471770.
- Wilson S.R., Strub P., Buist A.S., et al. Better Outcomes of Asthma Treatment (BOAT) Study Group. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med 2010 Mar 15;181(6):566-77. PMID: 20019345.
- Naik A.D., Kallen M.A., Walder A., et al. Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication. Circulation 2008 Mar 18;117(11):1361-8. PMID: 18316489.
- Clever S.L., Ford D.E., Rubenstein L.V., et al. Primary care patients' involvement in decision-making is associated with improvement in depression. Med Care 2006 May;44(5):398-405. PMID: 16641657.
- Da Silva D. Evidence: Helping people share decisions. A review of evidence considering whether shared decision making is worthwhile. 2012 June. London, England: Health Foundation.
- Schoen C., et al. Bending the curve: options for achieving savings and improving value in U.S. health spending. The Commonwealth Fund. Commission on a High Performance Health System. December 2007. http://www.commonwealthfund.org/publications/fund-reports/2007/dec/bending-the-curve--options-for-achieving-savings-and-improving-value-in-u-s--health-spending.
- Duncan E., Best C., Hagen S. Shared decision making interventions for people with mental health conditions. Cochrane Database Syst Rev 2010 Jan 20;(1):CD007297. PMID: 20091628.
- Hamann J., Langer B., Winkler V., et al. Shared decision making for in-patients with schizophrenia. Acta Psychiatr Scand 2006 Oct;114(4):265-73. PMID: 16968364.
- Loh A., Simon D., Wills C.E., et al. The effects of a shared decisionmaking intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns 2007 Aug;67(3):324-32. PMID: 17509808.