4 June 2010
Glyn Elwyn: linking pin between scientific research and general practice
Providing patients with usable information will get them more involved. As a result, a patient will have a better understanding of his situation and be prepared for the possible side effects of his treatment. When a patient is well-informed, he can partially decide which treatment is best suited for him.
CAPHRI’s visiting professor, Glyn Elwyn, carries out research in the area of Shared Decision Making, and develops tools that help health professionals to inform their patients. Apart from his research work, he is still rooted in everyday practice as a general practitioner for half a day a week.
“Shared Decision Making is an approach to communication between health professionals and patients”, Professor Elwyn briefly summarises. “Patients are involved in the decision making.”
Information
“As a professional, you provide the information that supports the patients to make a decision. You check their preferences, give patients a clear view of the situation and provide them with the possible treatments, the benefits and side effects of each. Once a patient knows all the facts he wants to share in making the decision of which treatment is best suited for him. It creates involvement. For example, women diagnosed with early-stage breast cancer face a difficult decision about their treatment. They can either opt for a full mastectomy or have breast conservation surgery followed by radiotherapy. Both these treatments are equally likely to have a successful outcome. Both treatments have their benefits and their side effects. With one treatment a woman will lose a breast but not with the other.”
Process
“It’s a process”, Elwyn stresses. “It’s more than giving information. It’s helping patients understand and helping them make a decision. But you also help patients with their emotions. I call that 'constructing the preference'. During the process of decision making the understanding of the situation and the patient's emotions can change.”
Patients’ involvement
Elwyn regards it as essential to be open and honest with the patient. “When there are side effects, tell them to the patient. With treatments nowadays, they often don’t know what exactly is going to happen. When side effects start to occur they get annoyed and the confidence and involvement in the treatment decreases, sometimes even resulting in law suits. With Shared Decision Making, patients know beforehand what is going to happen and side effects won’t come as a surprise.”
Responsibilities
Shared Decision Making requires a new attitude of health professionals, but also of patients. Elwyn: “The patient gets responsibilities. This can be unsettling. They need to get used to it. It is a bit like tasting beer for the first time. The first drink can leave a bad taste, but once you get used to it, you like it. But it will get patients involved. They know what is going on and share the decision. As a result they are more motivated to follow the treatment.”
Practice
“For a health professional, communication is important. As a general practitioner, for example, you have a long-term relationship with a patient. You are interested in their well-being. What often is missing in everyday practice is usable information or decision tools that help the health professional in their communication with the patient.”
Challenges
Before Shared Decision Making is widely implemented there are still a few challenges to be faced. “To effectively use Shared Decision Making, health professionals need more time, communication skills and information that is presented in a clear way so patients can understand it and can easily compare possible treatments. We already develop decision making tools that health professionals can use. The next steps are to develop more of these tools and also get them used in everyday practice.”
“Doctors are interested in Shared Decision Making but they don’t take the time to implement it. The system of general practice in England is measured by targets that a GP has to meet. If these targets are met there are no questions asked. This doesn’t help to implement Shared Decision Making. I think the Netherlands is headed in the same direction.”
Demand for information
Patients’ involvement is already happening more and more. Patients get a great deal of information from the internet. Elwyn: “Patients increasingly demand information from health professionals. They go on the internet and educate themselves. This demand for more information by patients will help to move health professionals in the direction of Shared Decision Making.”
Additional links
Shared decision making
Decision aids
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