SHERPA: a new model for clinical decision making in patients with multimorbidity

Abstract

Healthcare professionals' clinical practice is steeped in both compassion and technical aspects of care, yet data on how to improve the care of patients with multimorbidity is limited(1). Two of the cornerstones of modern clinical practice -evidence-based medicine and the teaching of consultation skills -lack utility in making decisions with and for patients who have multimorbidity, especially in time-pressurised, metrics-dominated clinical environments. We have developed a new model which supports the translation of population-based, evidence-based medicine and complex consultation models to simpler, natural conversations about care appropriate for and agreed with individual patients.

Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults

“…How : Carefully observe patients' recovery after stressors, such as blood pressure after change of posture or level of functioning after hip replacement surgery. Take into account the patient's course of recovery after recent health stressors in predicting the recovery potential following future stressors. Explicitly take note of the observed interactions between the patient's signs and symptoms (eg, by applying the SHERPA framework) Express any clinical intuitions on the resilience of a patient by using the term in daily clinical communication with patients and colleagues. …”

“…This exploration may help increase awareness and make sense of the multisystem connections at all levels that contribute to the patient's varying course of recovery or decline and may offer unique opportunities for resilience management. A step‐by‐step plan for such innovative clinical reasoning was recently proposed in the Sharing Evidence Routine for a Person‐Centered Plan for Action (SHERPA) framework . The SHERPA step plan results in a network of problems written on paper that can facilitate shared decision making with patients and colleagues.…”

“…• Explicitly take note of the observed interactions between the patient's signs and symptoms (eg, by applying the SHERPA framework). 56 • Express any clinical intuitions on the resilience of a patient by using the term in daily clinical communication with patients and colleagues.…”

“…A step-by-step plan for such innovative clinical reasoning was recently proposed in the Sharing Evidence Routine for a Person-Centered Plan for Action (SHERPA) framework. 56 The SHERPA step plan results in a network of problems written on paper that can facilitate shared decision making with patients and colleagues. Rather than giving a snapshot of a patient's condition, the recovery trajectories of multiple subsystems (including the mental and social domains) are followed over time, beginning before the stressor and continuing throughout the clinical encounter, treatment, and the recovery or further decline.…”

From mental disorder to shared understanding: a non-categorical approach to support individuals with distress in primary care

“…Three linked, iterative (though not necessarily sequential) analytic steps are described below; these build on Sackett's clinical epidemiology and are relevant to a range of complex clinical scenarios. 11 Step one: prioritising key issues facing the patient now. At the core will be the emotions, thinking patterns, behaviours, physical illnesses, and social situation of the present.…”