1. North East of England MAGIC Team Making Good Decisions in Collaboration 2 hour V3.1 29.5.12 Shared decision making Extended Skills Training Workshop

2. Workshop Aims & Objectives Aim In-depth skills training in shared decision making. Learning Outcomes Have got a good overview of SDM Have understood and practiced a number of core skills in SDM. Have worked on the ‘next steps’ for you and your team.

3. Outline of workshop First Section Introductions Aims and objectives of the workshop What helps make good decisions? Refresher on SDM and identifying learning needs Second section Choice talk – what it is and how to do it Option talk – what it is and how to do it Third section – rehearsing the skills Fourth section Preference/decision talk Practicing a whole shared decision making consultation Final section Wrapping up consolidating Next steps

4. The workshop Maximising learning. Breaks and timing. Use of the Workbook, slides and references. Microskills and content of scenarios. Feedback. One caveat. Responsibilities as learners. Evaluation.

5. Case Discussion

6. Core skills in shared decision making

7. Key assumptions (Page 7) An informed patient is desirable and important to you as a health care professional. Engaging patients in treatment decisions where there are real options is a desired goal and health care professionals need to support individuals to achieve this. A patient who is not informed of the possible consequences of the options is not able to determine what is important to them.

8. SDM Consultation skills Choice talk Introduce preference sensitive decision. Respond to patient’s reaction Option talk Introduce options, detail pros and cons, check understanding, introduce decision support Deliberation Help patient to deliberate about options, could be supported by decision specific / generic decision support tool. Preference/decision talk Establish patient’s personal preferences Decision Immediate or delayed SDM consultation skills

9. Core Skills in SDM

10. So how do we do shared decision making?

11. Choice talk Core skills (page 9) Summarise & signpost a shift in the conversation. Introduce the idea of choice. Justify the introduction of choice & signpost ‘what’s important to you’. Check for reaction to choice. Defer closure.

12. Option Talk Core Skills (page 10) Check existing knowledge Introducing decision support (if appropriate) Explore together List options Describe options Describe possible benefits and risks Checking understanding

13. Exercise – Choice and Option talk Instructions (page 13) Starting from the point at which you are moving onto choices and options for management Each participant in group has around 3 minutes to practice with the ‘patient’. You are to stop and start and ask for ideas. Others in the group will support, offer descriptive and constructive feedback and refine the skills.

14. Preference/decision talk Core Skills (page 12) Summarise and check preferred next step (move to decision or more time?) Check ‘what is important to you’ Move to making a decision.

15. So how about practicing the whole thing (including preference talk ) ?

16. Exercise –Full rehearsal – including preference and decision talk Instructions First clinician to start rehearsal from the point in consultation where “there are some choices available to you...” Rehearse and feedback / discuss with help of your Facilitator Use the laminated checklist to act as an aide memoire.

17. Identifying you personal ‘take homes’ from the session: 5 minutes At this stage it is helpful to identify what have you actually learned from these exercises Spend 5 minutes just on your own and jot something down in the workbook - page 16

18. Goal setting and planning next steps If we were the best shared decision making professional/ team we could be in 1 years time – What would we be doing that we are not doing now? What are the key components of this SDM vision? What are the next steps for you personally? What are the next steps for the team – where will you focus? How will you know it is helping?

19. Next steps You need to go on practicing the skills. You need some systems in place (website and your own resources). We can support you - just ask. The MAGIC program offers rapid testing and feedback so you can find out what difference all this is making. Please fill in the evaluation form for today’s event – we really want to know more about what has worked well and what needs changing

20. d.p.c.tomson@ncl.ac.uk The MAGIC programme is supported by The Health Foundation, an independent charity working to improve the quality of healthcare in the UK Thank you