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Shared Decision-Making for Periodontal Care (Shared decision making:…
Shared Decision-Making for Periodontal Care
Shared decision making:
collaborative process that recognizes a patients right to make decisions about his or her care once fully infomred about the options
Periodontal treatment is always based upon the best available evidence, but many times there will be more than a single course of treatment that could benefit an individual
process in which patients and clinicians work together
When is it appropriate?
for any dental health decision where there is more than one reasonable option
Evidence based health care
a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values
Systematic review
summarizes the result of available carefully designed health care studies (controlled trials)
Cochrane Dateabase of Systemic REview
for busy practioners who want to integrate high-quality science to patient
group was formed to organize medical research info in a systematic way to facilitate the choices that health professionals, patients, policy makers, and others face in health care interventions according to the principles of evidence based care
Share Information
Discuss and agree on goals
Jointly reivew plan
Record and share plan
Agree on follow-up schedule
Jointly develop care plan
(back to) Share information
FIVE essential steps of decision Making
SEEK your patients participation
HELP your patient explore and compare treatment plans
ASSESS your patients values and preferences
REACH a decision with your patient
EVALUATE your patients decision
SHARE approach
five-step process for shared decision making that includes exploring the benefits and risks of each care/treatment options through meaningful discussion about what matters most to the patient
Two Sources of Expertise
Clincian's Experience
Diagnosis of Condition
Disease of Etiology
Prognosis
Treatment options
Outcome probabilities
Patient's Expertise
Experience in condition
Circumstances (family values, finances)
Attitude to risk
Values
Preferences
Improved Treatment options
patients frequently do not understand recommended treatment options, or risks and benefits
on the other hand, clinicians do not fully grasp that treatment outcomes that patient prefers
ADHA code of ethics states patient has a right to informed consent PRIOR to treatment
they have the right to full disclosuse of all relevant information so that they can make informed choices about their care
Informed Consent: a patients voluntary agreement to proposed treatment
Patient can give consent to treatment after achieving an understanding of the relevant facts, benefits, and risks involved
Reasonable Patient Standard
health care provider must disclose all information that a rational patient would want before making a choice to pursue or reject a treatment or procedure
WHo is responsible for information patient?
standard is that the health care provider who performs the treatment is ultimately responsible to informing the patient and obtaining consent
** When discussing treatment outcomes, it is important not to appear to guarantee a treatment outcome to the patient
Informed Refusal
an individuals right to refuse all or a portion of the proposed treatment
Requires that recommended treatment, alternate treatment options, and the likely consequences of declinign treatment have been explained in language understood by the patient.
patient always has the right to refuse proposed periodontal care