Court decision on costs in case of Ottawa Community Housing vs. Argos Carpets and Peter Foustanellas
Decision Support as a Clinical Skill Module II: Using the Ottawa Personal Decision guide
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Transcript of Decision Support as a Clinical Skill Module II: Using the Ottawa Personal Decision guide
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?