Connecting patients, practitioners, and regulators in supporting positive experiences and processes of shared decision making: A progress report

Abstract

This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person‐centred care and processes of shared decision making in implementing professional standards and reducing harms. Osteopathic patients report high levels of patient care. However, areas of consultations less likely to be rated as high included “fully understanding your concerns,” “helping you to take control,” and “making a plan of action with you,” suggestive of a paternalistic approach to care and a barrier to the effective implementation of standards. This programme explored how to support patients and practitioners to make more explicit what is important to support consultations with better communication in accordance with standards. A series of workshops took place involving approximately 80 participants, which explored and identified practitioner and patient values; these were themed to develop a common framework and tested using case studies. Aspects of what enables or presents a barrier to a positive consultation were further explored with real patient narratives, and a range of resources were subsequently developed, which may support patients and practitioners to make explicit what is important to them in a consultation. A series of approaches and tools were then developed for piloting including patient curriculum vitae; patient goal planner; patient animation to support preparation for an appointment; infographic: a patient poster or leaflet; practitioner reflective tool; and an audio recording to increase awareness and understanding of values‐based practice. In conclusion, a range of approaches may help to support patients and practitioners to make explicit what is important to them in a consultation. The next phase of our programme will use a range of methods including cluster sampling, pre‐testing and post‐testing with the Consultation and Relational Empathy (CARE) measure tool, and interviews and focus groups with users and practitioners to demonstrate impact.

Connecting Patients, Practitioners and Regulators in Supporting Positive Experiences and Processes of Shared Decision-Making: A Case Study in Co-production

“…As in Jennifer's story, this is not always self-evident: Jennifer presented with pain and stiffness in her neck, but her response to being examined pointed to underlying concerns that limited her engagement and there was little, if any, evidence of shared decision-making. These resources are listed with links below (see [8] and Guide to Further Sources). As noted earlier, they have been generally well received, at this early stage, and we plan more formal testing of their impact in the next stage of the project.…”

“…These have been well received by practitioners and patients, and in a further phase of the project, we plan to assess their actual impact in practice. For details including links to the on-line resources please see [8].…”

“…The project as a whole is described in detail elsewhere [8]. We focus in this chapter on the insights it provided about the role of cultural values as a bridge between osteopaths, their patients and the regulator.…”

Interactions between persons—Knowledge, decision making, and the co‐production of practice

“…Fiona Browne and colleagues from the General Osteopathic Council report on an inclusive process aimed at promoting person‐centred care and SDM in osteopathic practice . Discussions involving regulators, patients and practitioners attempted to identify patient and practitioner values, testing their application by using methods including case studies and considering barriers with reference to real patient narratives.…”

“…It includes papers on the nature of reasoning and evidence, the on‐going problems of how to “integrate” different forms of scientific knowledge with each other, and with broader, humanistic understandings of reasoning and judgement, patient and community perspectives . Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under‐developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on SDM, analysing its proper meaning, its role in policy, methods for realizing it and its limitations in real‐world contexts …”