Encouraging shared decision-making in
Victorian health services
13 October 2014
Cath Harmer
A/Manager
Policy and Projects, Rural Health
Catherine.Harmer@health.vic.gov.au
Shared Decision Making
• Shared decision making (SDM) is a collaborative
process that allows patients and their providers to
make health care decisions together, taking into
account the best scientific evidence available, as well
as the patient’s values and preferences.
(Informed Medical Decisions Foundation
www.informedmedicaldecisions.org/what-is-shareddecision-making/ )
Ottawa Hospital Research Institute
Two conceptual frameworks
• Interprofessional SharedDecision-Making
• Ottawa Decision Support Framework
https://decisionaid.ohri.ca/models.html
Victorian history – shared decision-making as
definition of participation.
“Participation occurs when consumers, carers and
community members are meaningfully involved in
decision making about health policy and planning,
care and treatment, and the wellbeing of
themselves and the community. It is about having
your say, thinking about why you believe in your
view, and listening to the views and ideas of
others. In working together, decisions may include
a range of perspectives.”
(Doing it with us not for us, 2006, 2009, 2011
www.health.vic.gov.au/consumer )
Evaluating Effectiveness of Participation Projects
• Eight evaluations over six years based on the principles of
consumer participation, using evidence based information and
building the evidence on how shared decision-making improves
outcomes for:
• Residents in aged care – stories mapped with families and residents and
reduction in inappropriate use of psychometric medication for dementia
• People living with a mental health illness accessing care in emergency
departments
• Community consultation to plan and guide service development
• Staff training developed and led by consumers and carers and supported
by health professionals on working with people with a dual diagnosis of
alcohol/drugs and mental health illness
Supporting shared decision-making
Evaluating Effectiveness of Participation Projects were supported
by:
• Funding for project officer
• Encouraging collaboration with tertiary research centres
• Providing the expertise of the Cochrane Consumer and
Communication Review Group – Centre for Health
Communication and Participation at La Trobe University
www.latrobe.edu.au/aipca/about/chcp
• Final report being a draft submitted to a peer reviewed journal
• Allowing project development time and implementation time
over two year period.
Supporting shared decision-making
• Implementation of the National Safety and Quality
Health Service Standards (Australian Commission on
Safety and Quality in Health Care
http://www.safetyandquality.gov.au/ourwork/accreditation-and-the-nsqhs-standards/
• Victoria’s online education NSQHS Standards
resources for health service staff including module on
Person and Family Centred Care forthcoming at
www.health.vic.gov.au/accreditation
Victoria’s new resources – Mental Health Act 2014
•
The Mental Health Act 2014 places consumers and carers at the centre of mental
health treatment and care.
•
The legislation embeds supported decision-making which promotes strong
communication between practitioners, patients and their families and carers and
includes mechanisms such as:
•
Advance statements to record their treatment preferences in case they become
unwell and need compulsory mental health treatment;
•
A nominated person who can receive information about the patient so they can
provide the patient with support; and
•
A second psychiatric opinion that will enable patients to better understand their
illness and to empower them to participate in decision making about their treatment.
•
Supported decision making requires a fundamental shift in the way clinicians
provide compulsory mental health treatment and engage with people with mental
illness ( www.health.vic.gov.au/mentalhealth/mhact2014/index.htm )
Victoria’s new resources – Advanced Care Planning
•
Victorians accessing health services will have the opportunity to express their
preferences for future treatment and care through advance care planning so that
they can have confidence that the health services are providing the treatment and
care that they want.
•
Successful advance care planning depends on services having an organisational
commitment to delivering person-centred care through client-clinician collaboration.
The four priority action areas outlined in the strategy are:
•
Establishing robust systems so that your organisation can have the conversation.
•
Ensuring you have an evidence-based and quality approach to have the
conversation.
•
Increasing your workforce capability to have the conversation.
•
Enabling the person you are caring for to have the conversation
www.health.vic.gov.au/acp/strategy.htm
Victoria’s new resources – Integrating consumer
participation and evidence based care
• “Current consent processes do not appear to be ideal
for many doctors. In particular, junior doctors are often
not confident taking consent for surgical procedures
and require more support to undertake this task. This
might include written information for junior staff,
observation by senior colleagues when undertaking the
task and ward-based communication skills teaching on
consent taking.” (UK two teaching hospitals)
(Wood et al, Health expectations, 2014, Sept, Doctors'
perspectives of informed consent for non-emergency
surgical procedures: a qualitative interview study.)
Victoria’s new resources – Integrating consumer
participation and evidence based care
• Victorian clinicians obtaining informed consent through
shared decision-making considering evidence based
treatment, risks and benefits with the person.
• Department making available more than 300 patient
information brochures on specialist medical services.
• Plain language, evidence-based brochures will be accessible
electronically and free of charge to all Victorian public health
services.
• ‘Lite’ versions of many of the brochures will also be available
to all Victorians through www.betterhealth.vic.gov.au/
• A webinar of the metropolitan education and training
workshop held in September 2014 is now available at
www.health.vic.gov.au/consumer/health-literacy.htm
Thank you