Beecher Carlson 10 | HEALTHCARE RISK MANAGEMENT REVIEW | Annual 2016 • What role does religion, faith, or spirituality play in your medical choices? • • In terms of future medical care, what goals would you want for your medical treatment (conservation of resources, prolongation of life, focus on pain management, provision of care outside of a hospital)? Describe these circumstances in as much detail as possible. • What will most help you live well at this point in your life? BENEFITS OF SHARED DECISION-MAKING Shared decision-making is an essential element of patient-centered communication and one that enhances quality, aligns expectations, and better manages cost. Shared decision-making has also been shown to improve patient satisfaction and outcomes. Since shared decisionmaking is premised on enhanced communication between a patient and a provider, it is likely that this process may also reduce risk. WHAT SHARED DECISION-MAKING IS NOT There have been many providers critical of the shared decisionmaking or advanced care planning process, so it is important to dispel type of patient engagement. Shared decision-making or advanced care planning is not about allowing a patient total freedom to dictate treatment. It is not about forcing the provider to deviate from best practice or evidence-based practice. Shared decision-making does not mandate that individuals other than the patient be part of the process, unless the patient requests mind has a right to determine what shall be done with his own body…” The Court expounded on the necessary elements of informed consent and stated that for consent to be truly informed the patient must be advised of the following: • The treatment / procedure that is recommended or to be done; • • Alternatives to the treatment / procedure being proposed; and • The risk of doing nothing. This traditional process for seeking a patient’s support for proposed care of the informed consent process centers around the execution of a legal form, which often serves to confuse a patient more than it educates. Since have regarding general health or quality of life. Advanced care planning or shared decision-making goes well beyond those traditional treatment WHAT IS ADVANCED CARE PLANNING OR SHARED DECISION-MAKING? The concept of shared decision-making began to appear in the literature in the late 1990s (following the passage of the Patient Self Determination Act) but gained little traction for a number of reasons: • • It took more time than providers believed they had. • The conversations were “revenue negative”; there was no billing code to enhance reimbursement for these conversations. • Providers did not know what questions to ask or how to use information provided. Shared decision-making or advanced care planning recognizes the or she ultimately wishes to receive. Unlike informed consent, it is not episodic or initiated only when a complex treatment or procedure is being contemplated but rather seeks to align a patient’s values, wishes, and preferences with the treatments available. Shared decision-making is not meant to address only “end of life” care issues; it attempts to align the expectations of the patient with the life. Expectations and preferences may change for the patient as he expectations are vital. Questions to ask in a shared decision-making discussion include: • What frightens you most about medical treatment?
HRMR Annual 2016-17
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