SHARE Approach Workshop Curriculum

Module 1—Shared Decision Making and the SHARE Approach: Training Guide

Contents

Module Goal/Aim
Module Learning Objectives
Timing
Learning Methodology Checklist
Materials Checklist
Instructor Preparation
Module 1 introduction (10 minutes)
   Slide 1. Cover Slide
   Slide 2: Module 1: Shared Decision Making and the SHARE Approach
   Slide 3: Module 1—Purpose
   Slide 4: Module 1—Learning objectives
   Slide 5: Patient and provider perspectives
   Slide 6: Discussion
Basics of shared decision making (10 minutes)
   Slide 7: The "What," "Why," and "When" of Shared Decision Making
   Slide 8: Definition
   Slide 9: Tool 1—Essential Steps of Shared Decision Making: Quick Reference Guide
   Slide 10: The SHARE Approach
   Slide 11: The SHARE Approach
   Slide 12: Nine essential elements (Makoul & Clayman)1
   Slide 13: Nine essential elements (Makoul & Clayman)1
   Slide 14: Why shared decision making is important?
   Slide 15: Benefits for your patients2-8
   Slide 16: Benefits for your organization8
   Slide 17: When to engage in shared decision making?
   Slide 18: What studies are showing11-13
   Slide 19: The "Who" and "How" of Shared Decision Making
   Slide 20: Who is involved in shared decision making in the clinical setting?
   Slide 21: Collaborative roles in shared decision making—Key Roles
   Slide 22: Collaborative roles in shared decision making—other team members
   Slide 23: Collaborative roles in shared decision making—other team members
   Slide 24: Collaborative roles in shared decision making
   Slide 25: Collaborative roles in shared decision making
   Slide 26: Supportive materials from AHRQ
   Slide 27: Using evidence-based decision aids to support shared decision making
   Slide 28: Benefits of using decision aids in shared decision making8
Health care encounter without shared decision making (7 minutes)
   Slide 29: Health Care Encounter Without Shared Decision Making (Video Presentation)
Discussion
Shared decision making: step-by-step (20 minutes)
   Slide 30: Rebecca & Dr. Miller
   Slide 31: The SHARE Approach—Step by Step
   Slide 32: The SHARE Approach Poster
   Slide 33: Presenting SHARE steps. . . 
   Slide 34: Tool 2—Expanded Reference Guide with Sample Conversation Starters
   Slide 35: Step 1—Seek your patient's participation
   Slide 36: Step 1—Seek your patient's participation—Tips
   Slide 37: Step 1—Seek your patient's participation—Conversation starters
   Slide 38: Discussion
   Slide 39: Patient Poster
   Slide 40: Engaging your patients to ask questions
   Slide 41: Step 2—Help your patient explore and compare treatment options
   Slide 42: Step 2—Help your patient explore and compare treatment options—Tips
   Slide 43: Step 2—Help your patient explore and compare treatment options—Conversation starters
   Slide 44: Step 3—Assess your patient's values and preferences
   Slide 45: Step 3—Assess your patient's values and preferences—Tips
   Slide 46: Step 3—Assess your patient's values and preferences—Conversation starters
   Slide 47: Step 4—Reach a decision with your patient
   Slide 48: Step 4—Reach a decision with your patient—Tips
   Slide 49: Step 4—Reach a decision with your patient—Conversation starters
   Slide 50: Step 5—Evaluate your patient's decision
   Slide 51: Step 5—Evaluate your patient's decision—Tips
   Slide 52: Step 5—Evaluate your patient's decision—Conversation starters
   Slide 53: Patient buy-in is essential to adherence
Health care encounter with shared decision making (8 minutes)
   Slide 54: Shared Decision Making in Action (Video Presentation)
Discussion
   Slide 55: Rebecca and Dr. Miller share a decision
Role play (25 minutes)
   Slide 56: Putting Shared Decision Making Into Action—Role Play Activity (Managing osteoarthritis pain with medicine)
   Slide 57: Instructions
Role-play debrief (10 minutes)
   Slide 58: Debrief
   Slide 59: Key takeaways 1
   Slide 60: Key takeaways 2
   Slide 61: Key takeaways 3
   Slide 62: Key takeaways 4
   Slide 63: Conclusion of Module 1
   Slide 64: Citations 1
   Slide 65: Citations 2
   Slide 66: Citations 3


Module Goal/Aim

The goals of this module are to provide an introduction to shared decision making, and for participants to understand the five steps of the SHARE Approach to shared decision making, including how to put it into practice.

Return to Contents


Module Learning Objectives

At the conclusion of this activity, the participant will be able to:

  • Define shared decision making.
  • List critical elements required in effective shared decision making.
  • Explain key steps for conducting shared decision making, including who is involved.

Return to Contents


Timing

This module will take 90 minutes to present. (Note to instructor: Specific breakdown of times allotted for discussion/activity will appear within the module).

Return to Contents


Learning Methodology Checklist

  • Large group discussion.
  • Small group work.
  • Videos on shared decision making with group discussion.
  • Role-playing activities.
  • PowerPoint slide presentation.

Return to Contents


Materials Checklist

  • LCD projector and laptop.
  • Internet access in the room where training is taking place; this is required to play Video 1 in Module 1. Internet access can also be used for Video 2, but is not required.
  • Flip chart (with tape or sticky band) or a whiteboard.
  • Markers.
  • Index cards with numbers 1 or 2 to place on tables for role playing.
  • Module 1 Participant Guide—one per participant (see details below under Instructor Preparation).
  • Print copies of AHRQ Publications (links below)—one each per participant for the role playing activity.

Return to Contents


Instructor Preparation

4 weeks before training.

Order multiple free copies of AHRQ Consumer and Clinician Summaries listed above from the AHRQ Publications Clearinghouse (800-358-9295) or order online at the AHRQ Publication Clearinghouse Web site (http://ahrqpubs.ahrq.gov). Ask for the publications by the title and number above and refer to order code E-8. Order enough copies for each workshop participant to receive his/her own copy of both summaries. You will be handing the Clinician and Consumer Summaries out to training participants for the role-playing activity. You may also click on the links below to download and print the PDFs.

Comparative Effectiveness and Safety of Analgesics for Osteoarthritis

2 weeks before training.

  • Email each participant links to each of the summaries listed above or PDF copies downloaded from the www.effectivehealthcare.ahrq.gov Web site (see above).

    In the email, ask each participant to prepare for the workshop by reading the summaries prior to attending. (NOTE: You will also be handing out print copies of the summaries at the Module 1 training session. However, it is helpful if participants are familiar with them prior to the role play.)

On the day of training.

  • Have the SHARE Approach screen saver showing on your computer to share with participants as they come into the classroom.
  • Have the Module 1: Shared Decision Making and the SHARE Approach PowerPoint file open and minimized on the computer.
  • Have Video 1— Shared Decision Making at Stillwater Medical Group (available at: http://vimeo.com/35274883) open and minimized on the computer.
  • Have Video 2—the AHRQ SHARE Approach Video (available at: http://www.ahrq.gov/shareddecisionmaking/tools/video/ and on the thumb drive you received in training) open and minimized on the computer.
  • Arrange tables to facilitate small group work or be prepared for participants to move to smaller groups.
  • Place table numbers on tables for role-playing groups. Assume four to five participants per workgroup.

Return to Contents


Module 1 Introduction (10 minutes)

Slide 1: Cover Slide

Slide 1: Cover Slide. The SHARE Approach. Essential Steps of Shared Decision Making. Workshop course

Training Guide Script:

Do: Open PowerPoint called, Module 1.

Return to Contents


Slide 2: Module 1: Shared Decision Making and the SHARE Approach

Slide 2: Module 1: Shared Decision Making and the SHARE Approach.

Training Guide Script:

Say: Module 1 is titled, Shared Decision Making and the SHARE Approach.

Return to Contents


Slide 3: Module 1—Purpose

Slide 3: Module 1--Purpose. Present information about the five-step SHARE Approach of shared decision making and how to implement it.

Training Guide Script:

Say: The purpose of this module is to present information about the five-step SHARE Approach of shared decision making and how to implement it.

Return to Contents


Slide 4: Module 1—Learning objectives

Slide 4: Module 1--Learning objectives. At the conclusion of this activity, the participant will be able to: Define shared decision making. List critical elements required in effective shared decision making. Explain key steps for conducting shared decision making.

Training Guide Script:

Say: At the conclusion of this module, the participant will be able to:

  • Define shared decision making.
  • List critical elements required in effective shared decision making.
  • Explain key steps to conduct shared decision making.

Return to Contents


Slide 5: Patient and provider perspectives

Slide 5: Patient and provider perspectives. http://vimeo.com/35274883. With permission from the Stillwater Medical Group, Stillwater, MN. (Image of patient from the Stillwater Medical Group video.)

Training Guide Script:

Say: Before we get into describing shared decision making and how to implement shared decision making in clinical practice, let's hear from some real patients and providers about what they think of shared decision making.

Let's watch a short video clip of actual patients and providers who explain how shared decision making has impacted their lives and their practice (permission received from the Stillwater Medical Group).

Do: Play video clip http://vimeo.com/35274883.

Return to Contents


Slide 6: Discussion

Slide 6: Discussion. How did the patients feel about their experience with their providers? (Two images of patients from the Stillwater Medical Group video.)

Training Guide Script:

Ask: How did the patients feel about their experience with their providers?

Say: This clip clearly shows the partnership between patient and provider and why shared decision making is of value.

Return to Contents


Basics of Shared Decision Making (10 minutes)

Slide 7: The "What," "Why," and "When" of Shared Decision Making

Slide 7: The What, Why, and When of Shared Decision Making.

Training Guide Script:

Say: Let's start by talking about the "what," "why," and "when" of shared decision making. What is it, why should we do it, and when should it be done?

Return to Contents


Slide 8: Definition

Slide 8: Definition. Shared decision making occurs when a health care provider and a patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences.

Training Guide Script:

Say: This next slide shows the definition of shared decision making. Shared decision making is when a health care provider and a patient work together to make a health care decision that is best for the patient.

The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences.

Return to Contents


Slide 9: Tool 1—Essential Steps of Shared Decision Making: Quick Reference Guide

Slide 9: Tool 1--Essential Steps of Shared Decision Making: Quick Reference Guide. (An image of Tool 1, Essential Steps of Shared Decision Making: Quick Reference Guide.)

Training Guide Script:

Do: Hold up Tool 1.

Say: Let's look at Tool 1, Essential Steps of Shared Decision Making: Quick Reference Guide. It is one of the tools we will be using today and what you will be using for your training in your community.

Return to Contents


Slide 10: The SHARE Approach

Slide 10: The SHARE Approach. The SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each health care option through meaningful dialogue about what matters most to the patient.

Training Guide Script:

Say: The SHARE Approach to shared decision making is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each health care option through meaningful dialogue about what matters most to the patient.

Return to Contents


Slide 11: The SHARE Approach

Slide 11: The SHARE Approach. Step 1: Seek your patient's participation. Step 2: Help your patient explore and compare treatment options. Step 3: Assess your patient's values and preferences. Step 4: Reach a decision with your patient. Step 5: Evaluate your patient's decision. Note: Refer to page 2, Tool 1.

Training Guide Script:

Say: The SHARE Approach employs five steps, each step beginning with a letter to spell S-H-A-R-E (a mnemonic aid) to help remember the steps. You will find this on page 2 of Tool 1. 

Do: Hold up your hand and move fingers/thumb as you say the five steps.

  • Seek your patient's participation.
  • Help your patient explore and compare treatment options.
  • Assess your patient's values and preferences.
  • Reach a decision with your patient.
  • Evaluate your patient's decision.

Return to Contents


Slide 12: Nine essential elements (Makoul & Clayman)1

Slide 12: Nine essential elements (Makoul & Clayman). Conducted a systematic review of the literature in 2006. Identified the most frequently referenced essential elements of shared decision making. The SHARE Approach includes these nine elements.

Training Guide Script:

Say: In 2006, researchers Makoul and Clayman conducted a systematic review of the literature to identify the most frequently referenced elements of shared decision making.

Based on the findings of their review, they described nine essential elements of shared decision making that should be included in any shared decision-making model.

The five steps of the SHARE Approach include the nine essential elements of shared decision making.

Return to Contents


Slide 13: Nine essential elements (Makoul & Clayman)1

Slide 13: Nine essential elements. 1. Define/explain problem. 2. Present options. 3. Discuss benefits/risks/costs. 4. Clarify patient's values/preferences. 5. Discuss patient ability/self-efficacy. 6. Discuss doctor knowledge/recommendations. 7. Check/clarify patient's understanding. 8. Make or defer a decision. 9. Arrange follow-up.

Training Guide Script:

Say: These nine elements of shared decision making were identified as essential by Makoul and Clayman.

  • Define/explain problem.
  • Present options.
  • Discuss benefits/risks/costs.
  • Clarify patient's values/preferences.
  • Discuss patient ability/self-efficacy.
  • Discuss doctor knowledge/recommendations.
  • Check/clarify patient's understanding.
  • Make or defer a decision.
  • Arrange follow-up.

Return to Contents


Slide 14: Why shared decision making is important?

Slide 14: Why shared decision making is important? In many cases there are several treatment options available. Evidence-based assessments of treatments and interventions often fail to identify one treatment as clearly superior to another. Shared decision making (guided by providers) can help patients understand the benefits and harms of the options and clarify their own values and preferences.

Training Guide Script:

Say: Shared decision making is important because in many cases, there are several treatment options available to a patient.

Often times, evidence-based assessments of treatment options don't identify one treatment that is clearly superior to another.

In these instances, patient's values and preferences are important for determining what the best treatment option is for a patient.

Shared decision making (guided by providers) can help patients understand the benefits and harms of the options and clarify their own values and preferences.

Return to Contents


Slide 15: Benefits for your patients2-8

Slide 15: Benefits for your patients. Shared decision making can: ◦Improve the patient's experience of care. Improve patient adherence to treatment recommendations--emerging evidence that it can help improve health outcomes.

Training Guide Script:

Say: Shared decision making has many benefits for the patient.

Shared decision making:

  • Improves the patient's experience of care.
  • Improves patient adherence to treatment recommendations; there is also emerging evidence that it can improve health outcomes.

Return to Contents


Slide 16: Benefits for your organization8

Slide 16: Benefits for your organization. Shared decision making can: Improve the quality of care delivered. Increase patient satisfaction. Note: You will learn more about patient and provider benefits from shared decision making in Module 4.

Training Guide Script:

Say: Shared decision making can benefit the provider organization by improving the quality of care delivered and increasing patient satisfaction.

We will discuss more about the benefits to patients and providers in Module 4.

Return to Contents


Slide 17: When to engage in shared decision making?

Slide 17: When to engage in shared decision making? Engage when your patient has a health problem that needs a treatment decision. Not every patient encounter requires shared decision making. Some patients may not want to or be ready to participate in shared decision making. A patient choosing not to participate in the decision-making process is still making a decision.

Training Guide Script:

Say: The shared decision-making process begins when your patient has a health problem that needs a treatment decision. Remember, not every patient encounter requires shared decision making.

Some patients may not want to or be ready to participate. The patient choosing not to participate in the decision making process is still making a decision.

Return to Contents


Slide 18: What studies are showing11-13

Slide 18: What studies are showing. Studies suggest that many health providers believe patients are not interested in participating in health care decision making. Evidence suggests that most patient want more information than given, and many would like to be more involved in their health decisions.

Training Guide Script:

Say: Studies suggest that many health care professionals believe that patients are not interested in participating in their health care decision making.

However, evidence suggests that most patients want more information than they are routinely given by their provider, and many would like to be involved in making their own health care decisions.

Return to Contents


Slide 19: The "Who" and "How" of Shared Decision Making

Slide 19: The Who and How of Shared Decision Making.

Training Guide Script:

Say: Let's now turn to the "who" and "how" of shared decision making. Who is involved, and how do we do it?

Return to Contents


Slide 20: Who is involved in shared decision making in the clinical setting?

Slide 20: Who is involved in shared decision making in the clinical setting? The entire medical team should be familiar with and involved in shared decision making. (Image of a diverse group of health care professionals.)

Training Guide Script:

Say: Who is involved in shared decision making in the clinical setting?

The entire medical team should be familiar with and involved in shared decision making.

Return to Contents


Slide 21: Collaborative roles in shared decision making—Key Roles

Slide 21: Collaborative roles in shared decision making--Key Roles. Patient. Actively participates and is the center of shared decision making. Physician, physician assistant, or nurse practitioner. Lets their patient know there is a choice and invites patient to be involved in the decision. Presents options and describes the risks and harms. Explores patient's values and preference. Note: Refer to page 6, Tool 1.

Training Guide Script:

Do: Refer to page 6 in Tool 1, the Quick Reference Guide.

Say: Key roles in shared decision making:

The patient is an active participant in and is at the center of shared decision making.

The primary health care provider, such as the physician, physician assistant, or nurse practitioner, communicates that a health care choice exists, and invites the patient to be involved in the decision. The provider presents the options, describes the risks and benefits of each, and explores patient's values and preferences.

Return to Contents


Slide 22: Collaborative roles in shared decision making—other team members

Slide 22: Collaborative roles in shared decision making--other team members. Decision coach (nurses, social workers, health educator). Helps assess factors impacting the patient's decisional conflicts. Provides support. Monitors progress. Screens what is influencing implementations. Side bar: What does decision conflict look like? Your patient may: Verbalize uncertainty about the choice. Waver between choices. Delay the decision. Question personal values or what is important to them. Be preoccupied with the decision. Show signs of distress or tension.

Training Guide Script:

Say: Other roles in shared decision making include other members of your staff:

A decision coach can be assumed by nurses, social workers, or health educators. A decision coach can help assess factors influencing patients' decisional conflicts, provide support to address decisional needs, monitor progress in decision making, and screen for factors influencing implementation.

As an aside, this right hand side bar lists some of attributes your patients may show if they are experiencing decisional conflict.

Return to Contents


Slide 23: Collaborative roles in shared decision making—other team members

Slide 23: Collaborative roles in shared decision making--other team members. Shared decision making manager/support staff. Organizes the clinical practice to incorporate shared decision making. Manages the library of decision aids and technologies. Manages the clinical processes.

Training Guide Script:

Say: A shared decision-making manager or other support staff can organize the clinical practice to incorporate shared decision making. This person manages the library of decision aids and technologies and manages the clinical processes.

Return to Contents


Slide 24: Collaborative roles in shared decision making

Slide 24: Collaborative roles in shared decision making. Family members and caregivers. Lend support in clarifying the patient's values and preferences. Serve as legal proxy for children, elderly, or seriously ill patients. (An image of a patient speaking with a clinician, with a family member or caregiver in the background.)

Training Guide Script:

Say: Family members or caregivers can be an important influence on decision making. They lend support in clarifying values or preferences. Family can be legal proxy for children, elderly, or seriously ill patients.

Return to Contents


Slide 25: Collaborative roles in shared decision making

Slide 25: Collaborative roles in shared decision making. Medical treatment specialists. Offer input when treatment options require input from specialists.

Training Guide Script:

Say: Other team members, including medical treatment specialists, may need to weigh in on the decision.

Return to Contents


Slide 26: Supportive materials from AHRQ

Slide 26: Supportive materials from AHRQ. Decision support resources are an important part of the how of shared decision making. (Image of AHRQ decision support resources, including brochures, and a laptop, tablet, and smart phone displaying AHRQ content.)

Training Guide Script:

Say: In addition to thinking about who is involved in shared decision making, we also want to consider how it is done. Much of the remaining portion of this module is about how you do shared decision making. But before we get into the detailed steps of how to do shared decision making, let's talk briefly about decision support resources that can assist the process of shared decision making.

Return to Contents


Slide 27: Using evidence-based decision aids to support shared decision making

Slide 27: Using evidence-based decision aids to support shared decision making. Rely on materials that have reliable, unbiased summaries of evidence-based research. AHRQ and other organizations have many evidence-based treatment option resources. AHRQ's Effective Health Care Program is a growing library of free, easy-to-read treatment option resources for many health conditions. More on decision support resources in Module 2. Note: Refer to pages 7-8, Tool 1.

Training Guide Script:

Say: Decision aids that have reliable, unbiased summaries of evidence-based research for many health conditions are crucial in shared decision making.

AHRQ and other organizations have many evidence-based treatment option resources that can facilitate the process of shared decision making with patients.

AHRQ's Effective Health Care Program has a growing library of free, easy-to-read treatment option resources for many health conditions.

We will learn more about these aid resources, how to use them, and how to access them in Module 2.

Pages 7 and 8 in Tool 1, the Quick Reference Guide can direct you how to find these resources.

Return to Contents


Slide 28: Benefits of using decision aids in shared decision making8

Slide 28: Benefits of using decision aids in shared decision making. Improves patient's knowledge of options. Results in patient having more accurate expectations of possible benefits and risks. Leads to patient making decisions that are more consistent with his/her values. Increases patient's participation in decision making.

Training Guide Script:

Say: The benefits of using decision aids include:

  • Improving patients' knowledge of their options.
  • Patients having more accurate expectations of possible benefits and risks.
  • Patients making decisions that are more consistent with their values.
  • Increasing patients' participation in decision making.

Return to Contents


Health Care Encounter Without Shared Decision Making (7 minutes)

Slide 29: Health Care Encounter Without Shared Decision Making (Video Presentation)

 

Training Guide Script:

Say: Before we explore the "how to" steps of shared decision making, I am going to show a short video clip of a health care appointment with a provider, without using shared decision making.

As you are watching this, please watch how the relationship between the patient and the provider progresses. Also pay attention to who is in charge of this dialogue. You may want to take some notes for our discussion following the video.

Do: Show Part 1 of the SHARE Approach Video.

Return to Contents


Discussion

Slide 30: Rebecca & Dr. Miller

Slide 30: Rebecca and Dr. Miller. Is this typical of the patient-provider interactions you've observed? How satisfied is Rebecca with the outcome of the encounter? Why? How satisfied is Dr. Miller with the outcome of the encounter? Why?

Training Guide Script:

Ask: Ask 1-2 participants the following questions:

  • Is this typical of the patient-provider interactions you've observed?
  • How satisfied is Rebecca with the outcome of the encounter? Why?
  • How satisfied is Dr. Miller with the outcome of the encounter? Why?

Return to Contents


Shared Decision Making: Step-By-Step (20 minutes)

Slide 31: The SHARE Approach—Step by Step

Slide 31: The SHARE Approach--Step by Step. The SHARE Approach Step by Step.

Training Guide Script:

Say: Keeping this clinical encounter in mind, let's move on to how to incorporate shared decision making into a clinical care patient-provider encounter. After learning how to incorporate the SHARE Approach, we will show another video clip that incorporates shared decision making.

Return to Contents


Slide 32: The SHARE Approach Poster

Slide 32: The SHARE Approach Poster. (Image of the SHARE Approach Poster.) The SHARE Approach--Essential Steps of Shared Decision Making. Five steps for you and your patients to work together to make the best possible health care decisions. Step 1: Seek your patient's participation. Communicate that a choice exists and invite your patient to be involved in decisions. Step 2: Help your patient explore and compare treatment options.   Discuss the benefits and harms of each option. Step 3: Assess your patient's values and preferences. Take into account what matters most to your patient. Step 4: Reach a decision with your patient. Decide together on the best option and arrange for a followup appointment. Step 5: Evaluate your patient's decision. Plan to revisit decision and monitor its implementation.

Training Guide Script:

Say: The SHARE Approach to shared decision making involves five steps. This slide shows the poster you have in your workshop materials, and it can be posted in your clinic.  You may want to post it in your office or cubical, in the break room or above the photocopy machine. The poster can help serve as a prompt for you and your team to use this five-step approach with your patients.

Return to Contents


Slide 33: Presenting SHARE steps...

Slide 33: Presenting SHARE steps... The mnemonic SHARE is a learning device to help you readily recall the steps in the SHARE Approach Model. You may find that you do not present them in linear order during encounters. The important takeaway is to address all five steps.

Training Guide Script:

Say: The mnemonic, SHARE, is a learning tool to help you readily remember the five steps.

You may find that you do not present them in "linear order" during your interactions with patients. For example, steps 1, 2, and 3 could all be going on simultaneously.

The important takeaway is to address all five steps.

Return to Contents


Slide 34: Tool 2—Expanded Reference Guide with Sample Conversation Starters

Slide 34: Tool 2--Expanded Reference Guide with Sample Conversation Starters. (Image of Tool 2, titled The SHARE Approach. Essential Steps of Shared Decision Making: Expanded Reference Guide with Sample Conversation Starters.)

Training Guide Script:

Do: Hold up Tool 2.

Say: Open Tool 2, The SHARE Approach. Essential Steps of Shared Decision Making: Expanded Reference Guide with Sample Conversation Starters, to page 3 to follow along for the five steps of shared decision making.

Return to Contents


Slide 35: Step 1—Seek your patient's participation

Slide 35: Step 1--Seek your patient's participation. Communicate that a choice exists and invite the patient to participate in the decision-making process. Many patients are not aware that they can and should participate in their health care decision making. Many patients are not aware of the uncertainty in medicine, and that the outcomes of various treatments are variable. Note: Refer to page 3, Tool 2.

Training Guide Script:

Say: Let's look at Step 1 on page 3 of the tool. Seek your patient's involvement.

  • Communicate that a choice of treatment exists and invite your patient to participate in the decision-making process.

Many patients are not aware that they can and should participate in their health care decision making.

In addition, many patients are not aware of the uncertainty in medicine, and that the outcomes of various treatments are variable.

Return to Contents


Slide 36: Step 1—Seek your patient's participation—Tips

Slide 36: Step 1--Seek your patient's participation—Tips. Tips: Summarize the health problem and communicate there may be more than one treatment choice. Ask your patient to participate with the health care team. Assess the role your patient wants to play. Include family/caregivers in decisions. Use cues to continually engage your patient. For example, I'd like your input. Note: Refer to page 3, Tool 2.

Training Guide Script:

Say: Each of the steps offer practical tips that you can use. I suggest you read through Tool 2 when you get back to your office. Soon, using one or more of the tips will become second nature to you during shared decision making.

Let's go over some tips to help you invite your patient to participate.

  • Summarize the health problem clearly and communicate there may be more than one treatment choice.
  • Ask your patient to participate with the health care team in the decision-making process. Help the patient understand he or she is being invited to ask questions, get answers, and discuss options with you.
  • Assess the role your patient wants to play in the decision-making process.
  • Provide ongoing cues during the interaction about why their input is important. For example, say, "I would like your input."
  • Ask your patient if he or she would like family and caregivers to participate.

Return to Contents


Slide 37: Step 1—Seek your patient's participation—Conversation starters

Slide 37: Step 1--Seek your patient's participation—Conversation starters. Conversation Starters: Now that we have identified the problem, it's time to think about what to do next. I'd like us to make this decision together. There is good information about how these treatments differ that I'd like to discuss with you before we decide on an approach that is best for you. I'm happy to share my views and help you reach a good decision. Before I do, may I describe the options in more detail? Note: Refer to page 3, Tool 2.

Training Guide Script:

Say: Here are some conversation starters to invite your patient's involvement:

  • "Now that we have identified the problem, it's time to think about what to do next. I'd like us to make this decision together."
  • "There is good information about how these treatments differ that I'd like to discuss with you before we decide on an approach that is best for you."
  • "I'm happy to share my views and help you reach a good decision. Before I do, may I describe the options in more detail?"

Return to Contents


Slide 38: Discussion

Slide 38: Discussion. Do you have other phrases that you use as conversation starters to get patients engaged?

Training Guide Script:

Ask: Do you have other phrases that you use as conversation starters to get patients engaged?

Do: Take 2-3 comments from the workshop participants.

Return to Contents


Slide 39: Patient Poster

Slide 39: Patient Poster. (Image of the Patient Poster.) Know your options. Three questions for your provider. What are my treatment options? What are the benefits and harms (risks)? Where can I find more information to help me decide? Learn about the benefits and risks of your treatment options: http://www.ahrq.gov/patients-consumers/treatmentoptions. Learn about questions to ask your provider: http://www.ahrq.gov

Training Guide Script:

Say: One of the tools available in your Participant Guide workbook is the Know Your Options patient poster to be placed in the clinic.

Return to Contents


Slide 40: Engaging your patients to ask questions

Slide 40: Engaging your patients to ask questions. Post the Know Your Options poster in your waiting room and exam rooms.  Find it: On your thumb drive. In your notebook. On the AHRQ Web site at www.ahrq.gov/shareddecisionmaking. Learn about AHRQ's Questions are the Answer campaign. Note: Refer to page 8, Tool 1.

Training Guide Script:

Say: You can also find this tool on your thumb drive, and it is available for free in the shared decision making toolbox on the AHRQ Web site.

This poster is designed to prompt patients to ask questions and become involved in their health care.

Part of the patient's responsibility is to ask questions of their provider.

AHRQ also has a question builder tool as part of its "Questions are the Answer" campaign to help patients prepare questions for their visit. The Web site for "Questions are the Answer" is on page 8 of Tool 1, the Quick Reference Guide.

Return to Contents


Slide 41: Step 2—Help your patient explore and compare treatment options

Slide 41: Step 2--Help your patient explore and compare treatment options. Discuss the benefits and risks of each treatment option. Use evidence-based decision-making resources to compare treatment options. Read more about decision-support resources in Module 2. Note: Refer to page 4, Tool 2.

Training Guide Script:

Say: Let's look at Step 2, which is to help your patient explore and compare treatment options. Turn to page 4 of Tool 2, The SHARE Approach. Essential Steps of Shared Decision Making: Expanded Reference Guide with Sample Conversation Starters.

This step involves discussing the benefits and risks of the treatment options, so the provider's knowledge about risks and benefits of a treatment and the use of evidence-based decision aids are very important to this step.

This is the step where evidence-based decision aids and other resources are very important.

In Module 2, you will learn more about using decision support resources to help you do so.

Return to Contents


Slide 42: Step 2—Help your patient explore and compare treatment options—Tips

Slide 42: Step 2--Help your patient explore and compare treatment options--Tips. Check for patient knowledge of the options. Clearly communicate risks and benefits of each option. Explain the limitations of what is known about the options. Use simple visual aids and evidence-based decision aids when possible. Summarize by listing the options.

Training Guide Script:

Say: Tips to help your patient explore and compare treatment options include:

Assess what your patient already knows about the options. Some patients gather their own information. Explore with your patient what he/she may already know about his/her treatment options.

List the treatment options, and describe them in plain language. Clearly communicate risks and benefits of each option.

Explain the limitations of what is known and unknown about the options and what would happen with no treatment. Offer evidence-based decision aid tools whenever possible.

Summarize by listing the options again.

Return to Contents


Slide 43: Step 2—Help your patient explore and compare treatment options—Conversation starters

Slide 43: Step 2--Help your patient explore and compare treatment options--Conversation starters. Conversation Starters. Here are some choices we can consider. Let me tell you what the research says about the benefits and risks of the medicine/treatments that you are considering. When introducing decision aids, you can say: I have some booklets I want to give you that have information about your condition and the treatment options. These tools have been designed to help you to understand your options in more detail. Note: Refer to pages 5-8, Tool 2.

Training Guide Script:

Say: Some conversation starters for helping your patient assess pros and cons of treatments options are on pages 5-8. Let's go over some of them now.

  • "Here are some choices we can consider."
  • "Let me tell you what the research says about the benefits and risks of the medicine/treatments that you are considering."
  • When introducing decision aids, you can Say: "I have some booklets I want to give you that have information about your condition and the treatment options."
  • "These tools have been designed to help you to understand your options in more detail."

Return to Contents


Slide 44: Step 3—Assess your patient's values and preferences

Slide 44: Step 3--Assess your patient's values and preferences. An optimal decision is one that takes into account patient preferences and values. Communicate with your patient about the outcomes that are most important to him or her. Side bar: What matters most to your patient? Recovery time. Out-of-pocket costs. Being pain free. Having a specific level of functionality. Note: Refer to page 9, Tool 2.

Training Guide Script:

Say: The third step in the SHARE model is to assess your patient's values and preferences. See page 9 of Tool 2, The SHARE Approach. Essential Steps of Shared Decision Making: Expanded Reference Guide with Sample Conversation Starters.

Some health care providers may not be aware of the outcomes that matter most to patients. In fact, studies have shown that heath care professionals aren't truly tuned in to the things that really matter to patients.

And other studies have shown that patient treatment decisions often change after patients become well informed about their available options and the associated risks.

The best decision for your patient is one that takes into consideration his/her preferences and values. Talk with your patient about what matters the most and what outcomes are the most important to him/her.

Return to Contents


Slide 45: Step 3—Assess your patient's values and preferences—Tips

Slide 45: Step 3--Assess your patient's values and preferences--Tips. Tips. Encourage your patient to talk about his or her values and preferences. Use open-ended questions. Listen actively to the patient and show empathy and interest. Acknowledge what matters to your patient. Agree on what is important to your patient.

Training Guide Script:

Say: Some tips to accomplish Step 3 are:

  • Encourage your patient to talk about what is important to him or her regarding the options.
  • Use open-ended questions. Avoid questions with yes and no answers.
  • Listen actively to your patient. Show empathy and interest in the effect that a problem is having on your patient's life.
  • Acknowledge the values and preferences that matter to your patient.
  • Come to agreement on what your patient prefers and is important.

Return to Contents


Slide 46: Step 3—Assess your patient's values and preferences –Conversation starters

Slide 46: Step 3--Assess your patient's values and preferences. Conversation Starters. When you think about the possible risks, what matters most to you? As you think about your options, what's important to you? Which of the options fits best with the treatment goals we've discussed? Is there anything that may get in the way of doing this? Note: Refer to page 9, Tool 2.

Training Guide Script:

Say: Some things you can say to get the conversation going about your patient's values and preferences are:

  • "When you think about the possible risks, what matters most to you?"
  • "As you think about your options, what's important to you?"
  • "Which of the options fits best with the treatment goals we've discussed?"
  • "Is there anything that may get in the way of doing this?"

Assessing preferences matter, especially when patients defer decisions to clinicians.

Find out what matters to the patient. This may greatly impact achieving satisfactory health outcomes and patient satisfaction.

Return to Contents


Slide 47: Step 4—Reach a decision with your patient

Slide 47: Step 4--Reach a decision with your patient. Decide together on the best option. Arrange for follow-up steps to achieve the preferred treatment. Note: Refer to page 10, Tool 2.

Training Guide Script:

Say: The fourth step in the SHARE model is to reach a decision with your patient about the treatment option that is best. Turn to page 10 of Tool 2, The SHARE Approach. Essential Steps of Shared Decision Making: Expanded Reference Guide with Sample Conversation Starters.

Making a decision may take time. Check to see if your patient needs more time to consider the options or discuss them with others.

After assessing the treatment options, including benefits and risks, and guiding your patient to express what matters the most to him or her in determining the best option, decide together on the best treatment option.

Your patient may choose to delegate the decision to someone else or decide not to make a decision. In that case, active surveillance may be the option.

Schedule follow-up appointments to carry out the preferred treatment or active surveillance.

Return to Contents


Slide 48: Step 4—Reach a decision with your patient—Tips

Slide 48: Step 4--Reach a decision with your patient--Tips. Ask your patient if he/she is ready to make a decision. Ask your patient if he/she needs more information. Schedule another session if your patient needs more time to consider the decision. Confirm the decision with your patient. Schedule follow-up appointments to carry out preferred options.

Training Guide Script:

Say: Tips to help move your patient to come to a decision after jointly talking about the pros and cons of the treatment are:

  • Ask your patient if he or she is ready to make a decision or if they have any additional questions.
  • Ask if he or she would like additional information tools, such as decision aids to help make a decision.
  • If more time is needed, schedule another session.
  • Confirm the decision by asking your patient to describe the option she or he chose.
  • Have other staff schedule appointments to carry out the preferred option.

Return to Contents


Slide 49: Step 4—Reach a decision with your patient—Conversation starters

Slide 49: Step 4--Reach a decision with your patient--Conversation starters. It's fine to take more time to think about the treatment choices. Would you like some more time, or are you ready to decide? What additional questions do you have for me to help you make your decision? So now that we had a chance to discuss your treatment options, do you have a preference for which treatment you would prefer? Which treatment do you think is right for you? Note: Refer to page 10, Tool 2.

Training Guide Script:

Say: Some actual dialogue to help move your patient to a decision includes:

  • "It's fine to take more time to think about the treatment choices. Would you like some more time, or are you ready to decide?"
  • "What additional questions do you have for me to help you make your decision?"
  • "So now that we had a chance to discuss your treatment options, do you have a preference for which treatment you would prefer? Which treatment do you think is right for you?"

Return to Contents


Slide 50: Step 5—Evaluate your patient's decision

Slide 50: Step 5--Evaluate your patient's decision. Support your patient so the treatment decision has a positive impact on health outcomes. For management of chronic illness, revisit decision after a trial period. Note: Refer to page 11, Tool 2.

Training Guide Script:

Say: Once a decision has been made, it will be important to follow up with your patient on how he or she is doing. Evaluate your patient's decision. This is the last step in the SHARE Approach to shared decision making. See page 11 of Tool 2, The SHARE Approach. Essential Steps of Shared Decision Making: Expanded Reference Guide with Sample Conversation Starters.

For patients facing life-threatening conditions, some of the decisions will be irreversible, so careful follow-up is needed during the treatment phase.

For decisions related to management of chronic disease, the decision should be revisited periodically.

Return to Contents


Slide 51: Step 5—Evaluate your patient's decision—Tips

Slide 51: Step 5--Evaluate your patient's decision--Tips: Make plans to review the decision in the future. Monitor implementation of treatment decision. Assist your patient with managing barriers to implementation. Revisit the decision if the option does not produce the desired health outcomes.

Training Guide Script:

Say: Some tips to aid in evaluating your patient's decision are:

  • Make plans to review the decision in the future. Decisions may be reviewed and changed if they are not working well.
  • Monitor the extent to which the treatment decision is implemented.
  • Help with managing barriers to implementing a decision. Provide access to self-management support programs or other resources.
  • Reconsider other options if the preferred option is not working.

Return to Contents


Slide 52: Step 5—Evaluate your patient's decision—Conversation starters

Slide 52: Step 5--Evaluate your patient's decision--Conversation Starters: Let's plan on reviewing this decision at our next appointment. If you don't feel things are improving, please schedule a follow-up visit so we can plan a different approach. Note: Refer to page 11, Tool 2.

Training Guide Script:

Say: To let your patient know that you will continue to evaluate the decision that was made, keep the communication avenues open by saying something, like:

  • "Let's plan on reviewing this decision at our next appointment."
  • "If you don't feel things are improving, please schedule a follow-up visit so we can plan a different approach."

Return to Contents


Slide 53: Patient buy-in is essential to adherence

Slide 53: Patient buy-in is essential to adherence. The patient is generally responsible for implementing many of the decisions that are made, particularly decisions made in a primary care setting (e.g. lifestyle changes or taking medications). Adherence to treatment is enhanced by shared decision making!

Training Guide Script:

Say: Patient buy-in is essential to adherence.

The patient, not the health care provider, is generally responsible for implementing many of the decisions that are made, particularly decisions made in a primary care setting, for example lifestyle changes or taking medications.

Patient adherence to treatment plans is enhanced by shared decision making!

Return to Contents


Health Care Encounter With Shared Decision Making (8 minutes)

Slide 54: Shared Decision Making in Action (Video Presentation)

Slide 54: Shared Decision Making in Action (Video Presentation).

Training Guide Script:

Say: Now let's take a look at the same clinical encounter we observed in the previous video clip, but now enhanced with shared decision-making strategies.

We will see Dr. Miller and Rebecca share a decision.

Look for the five steps of shared decision making as you watch this short video clip.

Do: Show Part 2 of the SHARE Approach Video: Rebecca and Dr. Miller Share a Decision (Note, this video clip identifies when each of the five steps of the SHARE Approach occur so that it is easier for the participants to view actions for each step in the SHARE Approach Model). 

Return to Contents


Discussion

Slide 55: Rebecca and Dr. Miller share a decision

Slide 55: Rebecca and Dr. Miller share a decision. How satisfied is Rebecca with outcomes of the encounter? How do you think shared decision making will impact Rebecca's health outcomes? How satisfied is Dr. Miller with the outcome of the encounter? Do you think that you might want to try using the SHARE Approach when you return to your job site?

Training Guide Script:

Ask:

  • How satisfied was Rebecca with the outcomes of the encounter?
  • How do you think shared decision making will impact Rebecca's health outcomes?
  • How satisfied is Dr. Miller with the outcome of the encounter?
  • Do you think that you might want to try using the SHARE Approach when you return to your job site?

Say: Note that incorporating the SHARE model didn't add much time to the encounter.

Return to Contents


Role Play (25 minutes)

Slide 56: Putting Shared Decision Making Into Action—Role Play Activity (Managing osteoarthritis pain with medicine)

Slide 56: Putting Shared Decision Making Into Action--Role Play Activity (Managing osteoarthritis pain with medicine).

Training Guide Script:

Say: After learning about the SHARE Approach to shared decision making, we'd like to take the next half hour to have you practice shared decision making.

The condition we will use for the role play during this workshop is managing osteoarthritis pain with medicines.

You received the AHRQ evidence-based consumer and clinician summaries related to this topic prior to the workshop, and copies of it are in your workbook. Hopefully, you have read these summaries in advance.

Do: Ask participants to break into groups of 4-6 people based on the size of your group and the amount of space in your room.

Pass out the SHARE Approach Role Play Activity handout.

Distribute the SHARE Approach Sample Conversation Starters handout. Table numbers are already on the tables.

Return to Contents


Slide 57: Instructions

Slide 57: Instructions. Break into your assigned group. Choose roles: Provider, patient, reporter, observers. Refer to the Conversation Starters handout and the SHARE Approach model as you role play. Refer to your consumer and clinician summaries during this activity. Role play: ◦Reporter asks for volunteers for provider and patient. Role play a shared decision-making encounter. Observers provide feedback.

Training Guide Script:

Say: Your handout outlines the instructions for this role-play exercise. They are also listed on this slide. After you have broken into your groups:

  • Choose roles: health care provider, patient, reporter, and observers.
  • Some groups will be working with case study 1. Others will be working with case study 2.
  • Refer to the consumer and clinician summaries as needed as you conduct the role plays.

The provider will role play a shared decision-making encounter with the patient.

  • For each step of the SHARE Approach, use one of the conversation starter phrases. Use one of the samples provided, or come up with your own.
  • The provider will go through all five steps of shared decision making with the patient.
  • At the end of the role play, observers provide feedback.

Be prepared to report your experiences with shared decision making at the end of the 25-minute role-play period. The reporter from each role play will report the experiences from the role play.

Return to Contents


Role-Play Debrief (10 minutes)

Slide 58: Debrief

Slide 58: Debrief. Summarize your group's role play. Could you fit all steps in? What was most challenging? What worked best? How long did it take? How difficult would this be to implement in real life?

Training Guide Script:

Do: After 25 minutes are up, ask the participants to get ready to debrief.

Say: Now it's time to debrief. Let's start with Table/Group 1 to report your role-play experiences.

Please summarize your group's role play, and address the following points in your report.

  • Could you fit all steps in?
  • What was most challenging?
  • What worked best?
  • How long did it take?
  • How difficult would this be to implement in real life?

Do: Call up the reporter from each table to report out, starting with Table/Group 1. Continue until all tables/groups have reported out.

Say: Great job with role playing. You are really getting the hang of using shared decision making in practice.

As time goes on, you will find that incorporating the SHARE Approach will come much more easily to you. Posting the poster and putting the screen saver on your computer can help remind you of the model.

Return to Contents


Slide 59: Key takeaways 1

Slide 59: Key takeaways 1. Shared decision making is a two-way street Occurs when a health care provider and a patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences.

Training Guide Script:

Say: Let's briefly review key takeaway information for Module 1.

Shared decision making is a two-way street.

It occurs when a health care provider and a patient work together to make a health care decision that is best for the patient.

The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences.

Return to Contents


Slide 60: Key takeaways 2

Slide 60: Key takeaways 2. The SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each health care option through meaningful dialogue about what matters most to the patient.

Training Guide Script:

Say: The SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each health care option through meaningful dialogue about what matters most to the patient.

Return to Contents


Slide 61: Key takeaways 3

Slide 61: Key takeaways 3. Conversation starters can help you engage patients as you present each of the SHARE Approach Model's five steps.

Training Guide Script:

Say: Conversation starters can help you engage patients as you present each of the SHARE Approach Model's five steps.

Return to Contents


Slide 62: Key takeaways 4

Slide 62: Key takeaways 4. Using evidence-based decision aids in shared decision making can: Improve patient's knowledge of options. Result in patient having more accurate expectations of possible benefits and risks. Lead to patient making decisions that are more consistent with their values. Increase patient's participation in decision making.

Training Guide Script:

Say: Using evidence-based decision aids in shared decision making can:

  • Improve patients knowledge of their options.
  • Result in patients having more accurate expectations of possible benefits and risks.
  • Lead to patients making decisions that are more consistent with their values.
  • Increase patients' participation in decision making.

Return to Contents


Slide 63: Conclusion of Module 1

Slide 63: Conclusion of Module 1. The SHARE Approach Essential Steps of Shared Decision Making. Five steps for you and your patients to work together to make the best possible health care decisions. Step 1: Seek your patient's participation. Communicate that a choice exists and invite your patient to be involved in decisions. Step 2: Help your patient explore and compare treatment options. Discuss the benefits and harms of each option. Step 3: Assess your patient's values and preferences. Take into account what matters most to your patient. Step 4: Reach a decision with your patient. Decide together on the best option and arrange for a followup appointment. Step 5: Evaluate your patient's decision. Plan to revisit decision and monitor its implementation.

Training Guide Script:

Say: This concludes the overview of the main points of shared decision making using the SHARE Approach.

The next module will expand on the importance of using evidence-based information in shared decision making in clinical practice.

Return to Contents


Slide 64: Citations 1

Slide 64: Citations 1. Text description is below the image.

Slide Content:

  1. Makoul G, Clayman ML; An integrative model of shared decision making in medical encounters. Patient Educ Couns 2006;60(3):301-12.
  2. Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, Vollmer WM; 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. PubMed PMID: 20019345.
  3. Clever SL, Ford DE, Rubenstein LV, Rost KM, Meredith LS, Sherbourne CD, Wang NY, Arbelaez JJ, Cooper LA. Primary care patients' involvement in decision-making is associated with improvement in depression. Med Care 2006 May;44(5):398-405. PubMed PMID: 16641657.
  4. 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. http://www.health.org.uk/public/cms/75/76/313/3448/HelpingPeopleShareDecisionMaking. pdf?realName=rFVU5h.pdf (230 KB)

Return to Contents


Slide 65: Citations 2

Slide 65: Citations 2. Text description is below the image.

Slide Content:

  1. Swanson KA, Bastani R, Rubenstein LV, Meredith LS, Ford DE. Effect of mental health care and shared decision making on patient satisfaction in a community sample of patients with depression. Med Care Res Rev 2007 Aug; 64(4):416-30. PubMed PMID: 17684110.
  2. Thompson L., McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry 2012 Jul 24;12:87. PMID:22828119.
  3. 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.
  4. 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).

Return to Contents


Slide 66: Citations 3

Slide 66: Citations 3. Text description is below the image.

Slide Content:

  1. Little P., Everitt H., Williamson I., et al. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ 2001. 322(7284):468-72. PMID: 11222423.
  2. Coulter A., Parsons S., Askham A. Where are the patients in decision-making about their own care? Health Systems and Policy Analysis 2008: p. 1-26.
  3. Levinson W., Kao A., Kuby A., et al. Not all patients want to participate in decision making. A national study of public preferences. J Gen Intern Med 2005 Jun;20(6):531-5. PMID: 15987329.
  4. Légaré F., Ratté S., Gravel K., et al. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. Patient Educ Couns 2008. Dec;73(3):526-35. PMID: 18752915.
  5. Guadagnoli E., Ward P. Patient participation in decision-making. Soc Sci Med 1998 Aug;47(3):329-39. PMID: 9681902.
  6. Murray E., Charles C., Gafni A. Shared decision-making in primary care: tailoring the Charles et al. model to fit the context of general practice. Patient Educ Couns 2006 Aug;62(2):205-11. PMID:16139467.

Return to Contents


SHARE Approach

Module 1 Role-Play Activity

Prior to the workshop, you received the following AHRQ materials:

  • Managing Osteoarthritis Pain With Medicines: A Review of the Research for Adults, an evidence-based consumer summary.
  • Analgesics for Osteoarthritis, an evidence-based clinician summary.

Osteoarthritis is the medical condition we will be using for the role-play case study today. Hopefully, you have read these summaries. 

Instructions for Role-Play Activity:

You will have 25 minutes for this role play. The instructions for this role-play exercise are:

  • Break into your assigned group/table.
  • Choose roles: Provider, patient, observers, and reporter.
  • Review Case Study 1 or Case Study 2 about two 70-year-old women with osteoarthritis.
  • Refer to The SHARE Approach Sample Conversation Starters handout for sample language to use during this role play activity.

Role-Play 1:

  • The reporter will ask an individual from the group to volunteer as the role-play provider and another to volunteer as the role-play patient.
  • Role play a shared decision-making encounter with your patient. 
    • For each step of the SHARE Approach, use one of the conversation starter phrases.
    • Go through all five steps of shared decision making with the patient.
  • At the end of the role play, observers provide feedback.

Change places for Role-Play 2.

Role-Play Case Study 1

Osteoarthritis Case Study
Ms. Jones is a 70-year-old woman with diagnosed osteoarthritis (OA), and she has moderate pain.
Until recently, she had been doing fine with OA pain by maintaining a healthy weight and exercise. In the past few months, she has been experiencing more OA pain, and she now wants to consider a modality to control the pain better.
In general, Ms. Jones does not like to take prescription or oral medications, if there is another option.
Her treatment options are:

  • Acetaminophen (Tylenol®).
  • Nonsteroidal anti-inflammatory drugs: NSAIDs (Advil®, Motrin®, Aleve®, and Celebrex®).
  • Skin creams (BENGAY®, Aspercreme®, Theragen®).
  • Supplements (glucosamine, chondroitin).

 

Role-Play Case Study 2

Osteoarthritis Case Study 2
Ms. Wilson is a 70-year-old woman with diagnosed osteoarthritis (OA), and she is in moderate pain.
Until recently, she had been doing fine with OA pain by maintaining a healthy weight and exercise. In the past few months, she has been experiencing more OA pain, and she now wants to consider a modality to control the pain better.
Ms. Wilson has a past medical history of peptic ulcers. In addition, Ms. Wilson is low income and concerned about the cost of prescription drugs.
Her treatment options are:

  • Acetaminophen (Tylenol®).
  • Nonsteroidal anti-inflammatory drugs: NSAIDs (Advil®, Motrin®, Aleve®, and Celebrex®).
  • Skin creams (BENGAY®, Aspercreme®, Theragen®).
  • Supplements (glucosamine, chondroitin).

 

Role-Play Reporting

Be prepared to report your experiences with SDM at the end of the 30-minute role-play period. The recorder from each role play will report the experiences from the role play.

Please address the following points in your report:

  • Summarize your group's role play.
  • Could you fit all the steps in?
  • What was the most challenging?
  • What worked best?
  • How long did it take?
  • How difficult would this be to implement in real life?

Return to Contents

The SHARE Approach

Sample Conversation Starters

Step 1: Seek your patient's participation

Try These Conversation Starters To Invite Participation
"Now that we have identified the problem, it's time for us to think about what to do next."
"There is good information about how these treatments differ that I'd like to discuss with you before we decide on an approach that is best for you."
"I want to go over all the options so we can find a path that works for you."
After being invited to participate and having the options outlined, patients may still want the health care provider to make the decision for them. In that case, the following may be useful to try:
"I'm happy to share my views and help you reach a good decision. Before I do, would you like more detail about your options?"

 

Step 2: Help your patient explore and compare treatment options

Try These Conversation Starters To Start Discussion About Options
"Let me list the options before we get into more detail about each of them."
"Here are some choices we can consider."
"Let's go over your options."
Try These Conversation Starters To Explore Pros and Cons
"Let me tell you what the research says about the benefits and risks of the medicines you are considering."
"These options may have different effects for you compared with other people, so I want to describe them."
"The treatments I just described are not always effective for everyone, and the chances of having side effects can vary from one person to another."
Try These Conversation Starters When Introducing Decision Aids
"These tools have been designed to help you understand your options in more detail."
"I have some booklets I want to give you that have information about your condition and the treatment options. They will be able to help you in your decision-making process."
"This online tool offers a handout as well as a video. The video highlights the pros and cons of each treatment option. Let's discuss your options and go over the benefits and risks at our next visit."
"These online resources provide information to patients about the importance of exploring your treatment options. They compare the benefits and risks of each and offer information on options that you may want to discuss at your next visit."

Step 3: Assess your patient's values and preferences

Try These Conversation Starters To Learn About Your Patients' Values and Preferences
"As you think about your options, what's important to you?"
"When you think about the possible risks, what matters most to you?"
"Which of these potential side effects worries you the most?"
"Which of the options fit best with treatment goals we've discussed?"
"Is there anything that may get in the way of doing this?"

Step 4: Reach a decision with your patient

Try These Conversation Starters for the Decision and Follow-up Phases
"It is fine to take more time to think about the treatment choices. Would you like some more time, or are you ready to decide?"
"What additional questions do you have for me to help you make your decision?"
"This is a big decision and it's important for you to consider which treatment option you prefer."
"Let's meet again next week. In the meantime, here is some information for you to read and think about. We can continue the discussion once you've had a chance to do that."
"Are there other people that you want to talk to in order to help you make this decision?"
"Now that we had a chance to discuss your treatment options, which treatment do you think is right for you?"

Step 5: Evaluate your patient's decision

Try These Conversation Starters for Prompting Future Evaluation
"Can we talk next [appropriate timeframe] to see how you are doing?"
"Let's plan on reviewing this decision next [appropriate timeframe]."
"If you don't feel things are improving, please schedule a follow-up visit so we can plan a different approach."

Return to Contents


Return to SHARE Approach Workshop

Page last reviewed December 2014
Page originally created September 2014
Internet Citation: SHARE Approach Workshop Curriculum. Content last reviewed December 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/workshop/module1/shareworkshop-mod1guide.html