A recent study published in the British Medical Journal (BMJ) proposes a simple three talk model for shared-decision making in the clinic. Have you been involved in a shared-decision making process, or have you simply been told what is best for you? Please have your say.
My problem is that in reality, very few MSologists practise shared-decision making. They tend to pay lip service to it. For example, I recently co-chaired a teaching course during which we discussed several case scenarios. The objective was to select an appropriate DMT for the cases presented. The problem is that none of the patients were in the room, so how could we engage them in shared-decision making? In other words, you make a decision for the patient and then you encourage them to agree with you. This is called paternalism.
The model is simple enough and should be easy to implement:
Team Talk: Let's work as a team to make a decision that suits you best.
Option Talk: Let's compare the possible options.
Decision Talk: Tell me what matters most to you for this decision.
Elwyn et al. A three-talk model for shared decision making: multistage consultation process. BMJ 2017;359:j4891 Objectives: To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design: Multistage consultation process. Setting: Key informant group, communities of interest, and survey of clinical specialities. Participants: 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialities. Results: After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision-making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions: The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.