1. Self-Management Support: Shared Decision-Making Stephen Taplin MD, MPH 3/21/07 Adapted from work by Michael G. Goldstein, MD Bayer Institute for Health Care Communication

2. Session Overview Panel Discussion: Examples from the field –Lake County –Others Group Discussion: Lessons Learned –What’s getting in the way? –Who is responsible for each part? –What has been working? What are your successes?

3. What is Self-Management Support? Help people: understand decide choose change behavior overcome barriers follow-through

4. What is the difference between Self-management and shared- decision making? See Handout #1 Both are about “support” –People will decide if they want to be screened –People will decide how they will manage their disease

5. Self-management People with chronic conditions must make ongoing adaptations in their daily lives. Self management encompasses all activities patients perform –to control their illness, –prevent future complications, –and cope with the impact of the disease & its treatment on themselves & others [i][i] Briss P., Rimer B., Reilley B., et al. (2004). Promoting Informed Decisions About Cancer Screening in Communities and Healthcare Systems. Am J Prev Med 26(1): 67-80

6. Shared Decision Making Shared decision making accounts for values and preferences in the treatment decision-making process, and is made up of one-on-one interactions to understand and consider: –the risks, benefits, health outcomes alternatives, and uncertainties of an action –and consider the patients values regarding the potential benefits and harms associated with the preventive service. Both the patient and the clinician provide information and express their preferences, and the patient engages at a decision-making level at which he or she feels comfortable.. Sheridan S. (2004). Shared decision making about screening and chemoprevention: A suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med 26(1): 56-66. Glasgow R.E., Orleans C.T., Wagner E.H., et al. (2001). Does the chronic care model serve also as a template for improving prevention? Milbank Quarterly 79(4): 579-612, iv-v

7. SMS needs vary across the spectrum of health care targets Patient Preferences and Values Behavior Getting a mammogramRoutine exercise Social, Community, Cultural and Environmental Factors Information

8. 5As - Brief Counseling A ssess (knowledge, behavior, readiness)A ssess (knowledge, behavior, readiness) A dvise and informA dvise and inform A gree (on goals and methods)A gree (on goals and methods) A ssist (overcome barriers)A ssist (overcome barriers) A rrange follow-upA rrange follow-up Whitlock et al, 2002 Am J Prev Med 22:267-84

9. Self-Management Support is an ongoing interactive process Assessment is key Respond and Tailor Activate and Empower Team Approach Multiple opportunities Follow-up on progress

10. What do we know that works? The process and environment matter –See handout #2