Person-Centred Care Including Deprescribing for Older People

There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person’s views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person’s priorities and the clinician’s priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies.

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Engaging older people in decisions about their healthcare: the case for shared decision making

Reviews in Clinical Gerontology ◽

10.1017/s0959259811000281 ◽

2012 ◽

Vol 22 (2) ◽

pp. 99-107 ◽

Cited By ~ 8

Author(s):

Joanne Lally ◽

Ellen Tullo

Keyword(s):

Atrial Fibrillation ◽

Decision Making ◽

Clinical Practice ◽

Healthcare Professional ◽

Older People ◽

Shared Decision Making ◽

Clinical Condition ◽

Decision Making Process ◽

Shared Decision ◽

Risks And Benefits

SummaryShared decision making in clinical practice involves both the healthcare professional, an expert in the clinical condition and the patient who is an expert in what is important to them. A consultation involving shared decision making enables an examination of the options available, consideration of the risks and benefits whilst incorporating the values of the patient into the decision making process. A decision is aimed at, which is both clinically appropriate and is congruent with the patient's values.Older people have been shown to value involvement, to varying degrees, in decisions about their care and treatment. The case of atrial fibrillation shows the opportunities for, and benefits of, sharing with older people decision making about their healthcare.

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023 PP: INVOLVING PATIENTS AND CARERS IN RESEARCH: THE EXPERIENCE OF OLDER PEOPLE IN THE SHARED DECISION-MAKING PROCESS IN ADVANCED KIDNEY CARE a

BMJ Open ◽

10.1136/bmjopen-2017-016492.41 ◽

2017 ◽

Vol 7 (Suppl 2) ◽

pp. bmjopen-2017-016492.41

Author(s):

N Thomas ◽

K Jenkins ◽

S Datta ◽

R Endacott ◽

J Kent ◽

...

Keyword(s):

Decision Making ◽

Older People ◽

Shared Decision Making ◽

Decision Making Process ◽

Shared Decision

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B-PO04-198 ATRIAL FIBRILLATION ABLATION SHARED DECISION-MAKING TOOL IMPROVED PATIENT KNOWLEDGE BUT NOT SATISFACTION WITH THE DECISION-MAKING PROCESS

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.890 ◽

2021 ◽

Vol 18 (8) ◽

pp. S359

Author(s):

Nicholas Sommers ◽

Jason C. Rubenstein ◽

James Oujiri ◽

Abdur Rahman Ahmad ◽

Marcie G. Berger

Keyword(s):

Atrial Fibrillation ◽

Decision Making ◽

Shared Decision Making ◽

Atrial Fibrillation Ablation ◽

Decision Making Process ◽

Patient Knowledge ◽

Shared Decision ◽

Decision Making Tool

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The role of a shared decision-making process in paediatric epilepsy surgery

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.119162 ◽

2021 ◽

Vol 429 ◽

pp. 119162

Author(s):

Michelle Gratton ◽

Bonnie Wooten ◽

Sandrine Deribaupierre ◽

Andrea Andrade

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Epilepsy Surgery ◽

Decision Making Process ◽

Shared Decision ◽

Paediatric Epilepsy

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Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy

Renal Replacement Therapy ◽

10.1186/s41100-021-00365-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kazuyoshi Okada ◽

Ken Tsuchiya ◽

Ken Sakai ◽

Takahiro Kuragano ◽

Akiko Uchida ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Japanese Society ◽

Healthcare Management ◽

Maintenance Hemodialysis ◽

Decision Making Process ◽

Healthcare Team ◽

Shared Decision ◽

Dialysis Therapy ◽

Terminal Stage

Abstract Background In Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese Society for Dialysis Therapy (JSDT) developed a proposal that was limited to patients at the terminal stage and did not explicitly cover patients with dementia. This proposal for the shared decision-making process regarding the initiation and continuation of maintenance hemodialysis was published in 2014. Methods and results In response to changes in social conditions, the JSDT revised the proposal in 2020 to provide guidance for the process by which the healthcare team can provide the best healthcare management and care with respect to the patient's will through advance care planning and shared decision making. For all patients with end-stage kidney disease, including those at the nonterminal stage and those with dementia, the decision-making process includes conservative kidney management. Conclusions The proposal is based on consensus rather than evidence-based clinical practice guidelines. The healthcare team is therefore not guaranteed to be legally exempt if the patient dies after the policies in the proposal are implemented and must respond appropriately at the discretion of each institution.

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The Lived Experiences of Parents Having a Child With a Brain Tumor During the Shared Decision-Making Process of Treatment

Cancer Nursing ◽

10.1097/ncc.0000000000000979 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ting-Yu Huang ◽

Pei-Fan Mu ◽

Yi-Wei Chen

Keyword(s):

Decision Making ◽

Brain Tumor ◽

Shared Decision Making ◽

Lived Experiences ◽

Decision Making Process ◽

Shared Decision

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Depressed Latinx Older Adults’ Shared Decision-Making Preferences

10.31234/osf.io/6z25r ◽

2021 ◽

Author(s):

Sara Romero ◽

Patrick Raue ◽

Andrew Rasmussen

Keyword(s):

Primary Care ◽

Decision Making ◽

Puerto Rican ◽

Shared Decision Making ◽

Decision Making Process ◽

Shared Decision ◽

Medical Conditions ◽

Depression Severity ◽

Related Information ◽

Health Related

The shared decision-making (SDM) model is the optimal patient-centered approach to reduce racial and ethnic health disparities in primary care settings. This study examined decision-making preferences and the desire to be knowledgeable of health-related information of a multiheritage group of depressed older Latinx primary care patients. The primary aim was to determine differences in treatment preferences for both general medical conditions and depression and desire to be knowledgeable of health-related information between older Puerto Rican adults compared to older non-Puerto Rican Latinx adults. We also examined whether depression severity moderated those relationships. A sample of 178 older Latinx patients were assessed on measures of decision-making preferences, information-seeking desires, and depression severity. Regression models indicated depression severity moderated the relationship between Latinx heritage and decision-making preferences that relate to general medical decisions, but not depression treatment. Specifically, Puerto Ricans with high levels of depression preferred to be more active in making decisions related to general medical conditions compared to non-Puerto Rican patients who preferred less active involvement. There was no difference between groups at low levels of depression as both groups preferred to be similarly active in the decision-making process. This investigation adds to the literature by indicating between-group differences within a Latinx older adult sample regarding decision-making preferences and the desire to be informed of health-related information. Future research is needed to identify other sociocultural characteristics that contribute to this disparity between Latinx heritage groups in their desires to participate in the decision-making process with their primary care provider.

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Communication skills and tips for Part 3 MRCOG Examination

Tasks for Part 3 MRCOG Clinical Assessment ◽

10.1093/oso/9780198757122.003.0006 ◽

2017 ◽

Keyword(s):

Decision Making ◽

Communication Skills ◽

Clinical Assessment ◽

Clinical Skills ◽

Real Life ◽

Information Gathering ◽

Shared Decision ◽

Good Communication ◽

Information Giving ◽

Treatment Information

Good communication skills form a fundamental principle of the patient- centred clinical consultation. The new Part 3 of the MRCOG, assesses candidates based on their ability to apply the core clinical skills in the context of real- life scenarios. It assesses five core skills domains, with three relating to communication skills; i) Communicating with patients and their families, ii) Communicating with colleagues and iii) Information gathering. Communication skills in the Part 3 clinical assessment can be assessed in many forms: … ● Exploring patient symptoms or concerns (information gathering) ● Explaining a diagnosis, investigation or treatment (information giving) ● Involving the patient in a decision (shared decision making) ● Health promoting activities ● Obtaining informed consent for a procedure ● Breaking bad news ● Communicating with relatives ● Communicating with other members of the health care team … In order to provide patient- centred care, doctors must treat their patients as partners, involving them in the decision making regarding their care and instilling in them a sense of responsibility for their own health. When the patient feels that they are part of the team it increases their satisfaction with care, increases treatment adherence and improves clinical outcomes. It is these skills that are assessed in clinical assessment tasks involving communication. Clinical assessment candidates are often assessed in two communication domains; Process and Content. In order to do well in the information gathering stations, you must be aware of the differential diagnoses that may arise with various presentations and how to explore each one independently and as a collection. When it comes to information giving or shared decision marking, candidates need to be familiar with the most recent Royal College of Obstetrics and Gynaecology guidelines and know how to interpret their meaning to the patient and their families. The Calgary- Cambridge Model is one of the most recognized communication theories in medical education (Kurtz, 1996). This theory can be adapted to fit into most clinical scenarios. Using the Calgary- Cambridge Model, you should be able to obtain the majority of the points related to process.

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