SHARED DECISION MAKING, THE BRIDGE BETWEEN PATERNALISM AND AUTONOMY.

Abstract

INTRODUCTION: Shared Decision Making (SDM) has been shown to be an effective tool in allowing patients to determine the treatment options best suited to their individual needs and is becoming the new standard of care in modern healthcare. It is invaluable in situations where reasonable options exist for a patient’s management, such as Neuro-Oncology. METHODS: A clinical decision grid was developed for three conditions, low and high grade gliomas and metastases. Three options were given to patients: best medical management or biopsy or resection (+/- adjuvant treatment) for gliomas and stereotactic radiosurgery or resection for metastases. The suitability, advantages and disadvantages were explained for each option and patients encouraged to choose the option that they felt suited them best. We analysed health care professional’s attitude towards SDM before and after training using the Advanced Quality Alliance (AQuA) questionnaire. We assessed patient’s response to consultations before and after the implementation of SDM using CollaboRATE questionnaire in the first cycle of a Plan Do Study Act (PDSA) process. RESULTS: Five members of staff were trained in SDM and in response to the 19 point questionnaire (AQuA) there was an overall 28% improvement from 65% to 93% (in their attitude to SDM following training). The breakdown will be presented. 3 decision grids were used in 44 patients by 2 neurosurgeons and CollaboRATE scores remained high and did not change after full implementation with mean scores of 26/27 (range 15–27). CONCLUSION: SSDM is a useful process that allows patients to make informed decisions regarding their treatment options. Although a significant improvement was seen amongst staff following the introduction of SDM, no difference was seen in the patient response analysis. This may relate to the department already using this methodology prior to its full implementation and the lack of sensitivity of the collaboRATE test.