Shared Decision Making

Question 1

how many problems on average per vet apointment

Answer 1

2.6 problems in need of preventative / diagnostic. / treatment / management decision

Question 2

what are the 3 decision making models

Answer 2

1. paternalistic
2. informed medical decision making
3. shared decision making

Question 3

what is the paternalistic model
what are the pros and cons?

Answer 3

Vet is making decisions, tells client what to do
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Advantages: More efficient
Disadvantages: Non-adherence, Client more likely to hold veterinarian solely accountable

Question 4

what is the informed decision making model?
- pros and cons?

Answer 4

client is making the decions, vet just gives information
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Advantages: Well-informed clients, clients hold themselves accountable for outcomes Disadvantages: Clients seek information elsewhere, veterinarians’ unspoken preferences could lead to frustration about client’s final decision

Question 5

what is the Shared Decision-Making (SDM) Model
pros and cons

Answer 5

client and vet work together
- information and recommendations, and values and preferences go both ways
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Advantages: Both parties are invested, increased adherence
Disadvantages: Often more time-consuming

Question 6

Defining Shared Decision-Making

Answer 6

“An approach where clinicians and clients* share the best available evidence when faced with the task of making decisions, and where clients* are supported to consider options, to achieve informed preferences”

Question 7

why use shared decision making?

Answer 7

• Affective-cognitive outcomes
• e.g., patient satisfaction, patient knowledge, reduced decisional conflict
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• Behavioral outcomes
• e.g., adherence
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• Health outcomes
• e.g., patient-reported health outcomes, symptom improvement, improvement in overall medical conditions.

Question 8

components of the three-talk model

Answer 8

1. team talk
   - lets work together
2. option talk
   - dicuss alternatives
3. decision talk
   - tell me what matters most to you…
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   its about making preference based decision for the clinet

Question 9

what behavours for the three-talk model are not really abserved in practice?

Answer 9

most often
- choice is not acknowledged
- partnership not established
- preferences not integrated

Question 10

what is the framing effect?
should we use it?

Answer 10

• Framing effect = presenting options in a way that influences the client’s perception of the value of different options or benefits and harms
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  we should avoid it

Question 11

what are the 5 steps of the 3 talk model

Answer 11

• Acknowledge Choice
• Establish Partnership
• Present Options
• Elicit Preferences
• Integrate Preference

Question 12

do vets usually talk about cost when discussing treatments?
- how is this discussion usually framed? what could be a good way?

Answer 12

cost only discussed 23% of the time
> 74.0% of these discussions were in relation to time / service provided?
> Only 14.4% discussed cost in relation to future health/wellbeing of the pet

Question 13

is the level of care received linked to cost or communication?

Answer 13

The level of care that pets receive has been linked to communication skills rather than cost itself

Question 14

how do odds of adherence change when a client receives a clear vs ambiguous recommendation

Answer 14

The odds of adherence are 7x greater when a client receives a clear recommendation, compared to clients who receive an ambiguous recommendation from their veterinarian

Question 15

Factors Associated with SDM - how do the following affect SDM scores
- length of appointment
- vet years in practice
- Client Income x Appointment Type
- vet burnout

Answer 15

• Length of Appointment
  > Higher SDM scores associated with longer
  appointment length
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• Veterinarians’ Years in Practice
  > SDM scores decreased as years in practice increased
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• Client Income x Appointment Type
  > Statistical interaction between client household income and appointment type – Generally, SDM scores decreased as income increased with the exception of the lowest income bracket.
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• Veterinarian Burnout
  > SDM scores decreased as veterinarian burnout scores increased

Question 16

how does Likelihood of a preference-sensitive decision change as the length of veterinarian-producer relationship increases

Answer 16

Likelihood of a preference-sensitive decision decreased as the length of veterinarian-producer relationship increased