SHARE Approach Workshop Curriculum

Module 1—Shared Decision Making and the SHARE Approach: Slides

Contents

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
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
Slide 29: Health Care Encounter Without Shared Decision Making (Video Presentation)
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
Slide 54: Shared Decision Making in Action (Video Presentation)
Slide 55: Rebecca and Dr. Miller share a decision
Slide 56: Putting Shared Decision Making Into Action—Role Play Activity (Managing osteoarthritis pain with medicine)
Slide 57: Instructions
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


Slide 1: Cover Slide

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Slide Content:

The SHARE Approach
Essential Steps of Shared Decision Making
Workshop course

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

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Slide Content:

Module 1
Shared Decision Making and the SHARE Approach

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Slide 3: Module 1—Purpose

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Slide Content:

  • Present information about the five-step SHARE Approach of shared decision making and how to implement it.

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Slide 4: Module 1—Learning objectives

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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.

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Slide 5: Patient and provider perspectives

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Slide Content:

(Image of patient from the Stillwater Medical Group video.)

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Slide 6: Discussion

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Slide Content:

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

(Two images of patients from the Stillwater Medical Group video.)

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

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Slide Content:

The "What," "Why," and "When" of Shared Decision Making.

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Slide 8: Definition

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Slide Content:

  • 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.   

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

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Slide Content:

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

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Slide 10: The SHARE Approach

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Slide Content:

  • 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.  

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Slide 11: The SHARE Approach

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Slide Content:

  • 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.

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

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Slide Content:

  • 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.

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

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Slide Content:

  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.

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Slide 14: Why shared decision making is important?

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Slide Content:

  • 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.

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Slide 15: Benefits for your patients2-8

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Slide Content:

  • 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.

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Slide 16: Benefits for your organization8

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Slide Content:

  • 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.

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Slide 17: When to engage in shared decision making?

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Slide Content:

  • 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.9-11
    • A patient choosing not to participate in the decision-making process is still making a decision.

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Slide 18: What studies are showing11-13

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  • 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.

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

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Slide Content:

The "Who" and "How" of Shared Decision Making

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

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

(Image of a diverse group of health care professionals.)

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

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  • 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.

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

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  • 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.

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

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  • 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.

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Slide 24: Collaborative roles in shared decision making

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  • 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.)

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Slide 25: Collaborative roles in shared decision making

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  • Medical treatment specialists.
    • Offer input when treatment options require input from specialists.

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Slide 26: Supportive materials from AHRQ

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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.)

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

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  • 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.

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

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Slide Content:

  • 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.

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

 

Slide Content:

Health Care Encounter Without Shared Decision Making
Video Presentation

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Slide 30: Rebecca & Dr. Miller

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Slide Content:

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?

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Slide 31: The SHARE Approach—Step by Step

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Slide Content:

The SHARE Approach Step by Step.

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Slide 32: The SHARE Approach Poster

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Slide Content:

(Image of the SHARE Approach Poster [PDF version - 559 KB].)

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.

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Slide 33: Presenting SHARE steps...

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Slide Content:

  • 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.

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

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

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

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Slide Content:

  • 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.

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

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Slide Content:

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.

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

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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.

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Slide 38: Discussion

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Slide Content:

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

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Slide 39: Patient Poster

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Slide Content:

(Image of the Patient Poster [PDF version - 317 KB].)

Know your options

Three questions for your provider.

  1. What are my treatment options?
  2. What are the benefits and harms (risks)?
  3. 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

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Slide 40: Engaging your patients to ask questions

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Slide Content:

  • Post the "Know Your Options" poster in your waiting room and exam rooms.  Find it:
  • Learn about AHRQ's "Questions are the Answer" campaign.

Note: Refer to page 8, Tool 1.

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

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Slide Content:

  • 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.

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

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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.

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

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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.

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

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Slide Content:

  • 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.

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

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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.

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

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Slide Content:

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.

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

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Slide Content:

  • Decide together on the best option.
  • Arrange for follow-up steps to achieve the preferred treatment.

Note: Refer to page 10, Tool 2.

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

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Slide Content:

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.

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

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Slide Content:

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.

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

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Slide Content:

  • 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.

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

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Slide Content:

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.

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

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Slide Content:

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.

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Slide 53: Patient buy-in is essential to adherence

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Slide Content:

  • 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!6-7,12

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

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Slide Content:

Shared Decision Making in Action.

Video Presentation.

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Slide 55: Rebecca and Dr. Miller share a decision

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Slide Content:

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?

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

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Slide Content:

Putting Shared Decision Making Into Action.

Role Play Activity.
(Managing osteoarthritis pain with medicine).

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Slide 57: Instructions

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Slide Content:

  • 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.

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Slide 58: Debrief

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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?

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Slide 59: Key takeaways 1

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Slide Content:

  • 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.   

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Slide 60: Key takeaways 2

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Slide Content:

  • 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.

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Slide 61: Key takeaways 3

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Slide Content:

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

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Slide 62: Key takeaways 4

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Slide Content:

  • 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.

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Slide 63: Conclusion of Module 1

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Slide Content:

(Image of the SHARE Approach Poster [PDF version - 559 KB].)

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.

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Slide 64: Citations 1

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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 (PDF File, 143 KB)

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Slide 65: Citations 2

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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).

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Slide 66: Citations 3

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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.

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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-mod1slides.html