1 Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Principles of Family Medicine Shared Decision Making and Patient Empowerment Dr. Zekeriya Aktürk

2 Our experiences as patients: did you ever feel powerless?

3 Objectives At the end of this session the participants will be able to; –discuss the definition of patient empowerment –discuss the status of patient empowerment in FP –explain the need for patient empowerment –explain the power/relationship graph –discuss the reasons of powerless patients –explain how to empower patients

4 What is it? an individual being an active member of his/her disease management team Laura E. Santurri. Patient Empowerment: Improving the Outcomes of Chronic Diseases Through Self-Management Education.

5 The idea behind Patients cannot be forced to follow a lifestyle dictated by others. Preventive medicine requires patient empowerment for it to be effective. Patients as consumers have the right to make their own choices and the ability to act on them

6 Why Patient Empowerment? Patients and physicians committed to joint decision-making Patients research own health conditions Patients today expect physicians to be team leaders and to provide clinical and educational support Physicians are the lead source of information, the most trusted source, and the source most likely to catalyze positive behavior change Magee, Relationship-Based Health Care in the US, UK, Canada, Germany, S. Africa, and Japan, 2003

7 Only 9% of consultations with surgeons and primary care physicians meet full criteria for informed decision making. Braddock JAMA 1999 Distinguishing elements of shared decision making occurred in 0-11% of audio taped patient interviews with general practitioners. Elwyn 2001 “.. Checking of understanding, and the involving of patients in decision making.. are rarely demonstrated” [in video taped consultations submitted for MRCGP examination]. Campion BMJ 2002 Why Patient Empowerment?

8 “People whose lives are affected by a decision must be a part of the process of arriving at that decision.” –John Naisbitt, Megatrends Why Patient Empowerment?

9 Power Relationship Partnership Transaction Keep Share The Power/Relationship Graph

10 ImposeDictate CompromiseCommon ground Problem Solving Power Relationship Partnership Transaction Keep Share

11 USAJapan China Sweden UK Italy Middle east France Russia Germany Countries Power Relationship Partnership Transaction Keep Share

12 How is it with you? NoPartially (sometimes)Yes 012 Total scoreSDM 0None 1-12Low 13-24Moderate 25-32High * Use this scoring table to calculate your own total SDM scores according to the distributed questionnaire.

13 Education Professional status/authority Knowledge Skills Expertise Experience On familiar territory GATEKEEPER TO HEALTHCARE SYSTEM Why is the concentration of power in this relationship with physician?

14 Patient is sick, weak, vulnerable, not feeling fully oneself… Patient may be afraid Patient in a state of dependency Lack of medical knowledge Lack of knowledge on the “system” and how it works Unfamiliar environment Why is the concentration of power in this relationship with physician?

15 Benefits of Patient Empowerment Learning from our patients Taking a proactive role Providing a support & information service to our patients and staff Complaint Resolution Negotiation & Mediation Building trust

16 Follow-up Management / treatment Presenting concern “patient’s story” History and physical exam Hypothesis Identified problem or diagnosis Identify choices Review pt’s preference for information Present evidence Respond to pt’s ideas, concerns and expectations re: management Assess partnership (review previous steps) DOCTOR - PATIENT COMMUNICATION Establish pt’s role in decision making Agree on an action plan Negotiate a decision Model for Clinical Problem Solving & ISDM Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8

/ 2017 Feeling vulnerable Not involved No dialogue Disempowered No Partnership No Voice in the System

/ 2018 Empowerment allows our relationships to grow in strength