Decision Support Decision Support as a Clinical Skillas a Clinical Skill

Module II:Module II:Using the Ottawa Personal Using the Ottawa Personal

Decision guideDecision guide

Last update: September 2008

Decisional NeedsDecisional conflict (uncertainty) Decision: type, timing, stage, leaningKnowledge & ExpectationsValues claritySupport/resourcesPersonal/Clinical Characteristics

QualityInformed, values-based ActionsDelay, continuance ImpactValues-based health outcomesReduce regret and blameAppropriate use & cost of health services

Decision Support1. Clarify decision and needs2. Provide facts, probabilities3. Clarify values4. Support/Guide/Coach5. Monitor/Facilitate progress

British Medical Journal 327:736-740, 2003

OTTAWA DECISION SUPPORT FRAMEWORK

Health Decisions Best Suited for the Ottawa DSF

No clear “choice” that’s right for No clear “choice” that’s right for everyoneeveryone

Stimulated by new circumstance, medical Stimulated by new circumstance, medical diagnosis, or developmental transitiondiagnosis, or developmental transition

Careful deliberation --- uncertain Careful deliberation --- uncertain outcomes (scientific uncertainty)outcomes (scientific uncertainty)

Options have different benefit/harm Options have different benefit/harm profiles that clients value differentlyprofiles that clients value differently

More effort in deliberation than in More effort in deliberation than in implementation implementation

Ottawa Personal Decision Guide

Clarify the Decision Clarify the Decision

Identify Decision Making Identify Decision Making NeedsNeeds

Explore Needs Explore Needs Plan Next StepsPlan Next Steps

Step 1: Clarify the Decision

Step 2: Identify Needs

Step 3: Explore Needs Support/Pressure

Client’s Characteristics

AgeAge GenderGender LocaleLocale OccupationOccupation EducationEducation LanguageLanguage EthnicityEthnicity

Medical diagnosisMedical diagnosis Duration of diagnosisDuration of diagnosis Marital statusMarital status Family compositionFamily composition Health status Health status

physicalphysical cognitivecognitive emotionalemotional socialsocial

Step 3: Explore NeedsKnowledge Values Certainty

ExampleExamplePatient with painful knee osteoarthritisPatient with painful knee osteoarthritis

ExampleExampleAssign ImportanceAssign Importance

Step 4: Plan Next Steps

Progress in Decision Making

LeaningLeaning: : Choice predispositionChoice predisposition Leaning towards a specific option?Leaning towards a specific option?

Certainty:Certainty: Best choice for you?Best choice for you?

Stage:Stage: Aware of options? Aware of options? Close to choosing?Close to choosing? Already made a choice? Already made a choice?

Experience using the OPDG

Using the Ottawa Personal Using the Ottawa Personal Decision GuideDecision Guide

Form groups of two• ‘Client’ making a difficult decision• ‘Practitioner’ interview

2. ‘Client’ choose a real decision (health decision, career, education, move, buy

a car)

3. ‘Practitioner’ interviews patient & documents on the Ottawa Guide

4. Discussion

Any Any Decision

What happened?What happened?

What helped?What helped?