Midwife Monday: What is shared decision making?

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Hello Monday. We had a lovely weekend that involved playing outside in the snow and the SUNSHINE! There’s an unsaid contest in the neighborhood for the neighbor that can pile up the most snow at the end of their driveway and make a makeshift sledding hill for all the neighborhood kids. I think the biggest hill was about 10 feet tall! Anyways, the sunshine felt amazing and we played outside for a good 2 hours.

Today we’re chatting about shared decision making – also known as SDM!

What is shared decision making?

Shared decision making is a process in which the patient and the provider discuss a treatment plan based on evidence (or lack of evidence); the patient and the provider then weigh possible risks and/or benefits of the treatment plan against the patient’s values. The whole idea is that the patient and provider are having a conversation together about the plan of care (National Learning Consortium, 2013).

Why is shared decision making important?

The short answer: in healthcare, there’s not always a right answer or just one option. It’s important for providers to review all possible avenues for care and for patients to understand that they have a choice. Additionally, patients that are vested in their plan of care are more like to stick with their treatment or care plan!

When patients participate in shared decision making….

  • They understand their condition or problem
  • They recognize the need to make a decision and that they understand all options
  • They understand the pros or cons of each option
  • They feel more confident talking to their provider
  • They are more likely to follow through with their plan (National Learning Consortium, 2013)

I’m a provider…how do I practice shared decision making with my patients? Try these tips:

  • Encourage patients to participate in discussions about their health
  • Review all options and the benefit/risk of each option
  • Review the patient’s goals and assist them in choosing an option most in line with their goals, the evidence, and the desired risk/benefit ratio
  • Encourage discussion about the decision
  • Encourage follow through with the decision or treatment plan (National Learning Consortium, 2013)

Why does shared decision making matter in pregnancy and birth?

Because your pregnancy and your birth should involve your values, opinions and choices. Often times, there is evidence for birth interventions, often times, there isn’t. It’s imperative you know when to ask why something is being done and consider that the intervention or treatment might not be appropriate for you, your baby, or your family.

What’s a shared decision making aid?

Shared decision making aids are tools for the provider and the patient to use together to navigate the decision together. The tools come in a variety of methods – a paper you can print out and write on; a tool you use online; a set of flashcards….see this example below from the Ottawa Personal Decision Guide:

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Want to check out more SDM resources? Check these out and share with your family and friends. The conversations in clinics and hospitals across the country (and the world) will only get better with SDM!

Okay, I know a little more about shared decision making. What do I do now?

  • Considering something like elective or medical induction of labor? Print out a decision aid, write down your questions or concerns, and bring it to your next visit!
  • Unsure about newborn circumcision? Bring a decision aid to your birth to talk to the pediatrician!
  • Unsure about contraception options? Considering an IUD (intrauterine device) versus a Nexplanon versus the NuvaRing? Bring a decision aid with your notes to your provider visit.

The possibilities are endless. I encourage you to at least review the questions and think about your values in each decision you make about your health, your child’s health and your family’s health. You won’t regret being informed!

Have a great week! The icicles are melting today…come on break up season!

Jamie

References

National Learning Consortium. (2013). Shared decision making: Fact sheet. Retrieved from https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf

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