Evidence-based Medicine On the Same Page™

The EBM Information Quest: Is it true? Is it useful? Is it usable?™

Delfini Co-founders: Michael E Stuart MD, President & Medical Director . Sheri Ann Strite, Managing Director & Principal

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Patient Decision-making

Here are some of the things we think matter to patients —

Delfini Framework for Patient Care

This is our suggested framework for considering evidence-based quality improvement projects in the context of major health care objectives in an idealized context. Click to view:

Patient Care Goals for Healthcare Organizations & Clinical Staff: An Ideal Framework [PDF]

This framework, the below Model for Patient Decision-making and tips for developing patient communication aids are available in our Patient Communication Aid Development Tips tool [WORD]. Also available at Resources > Tools > Patient Tools.

Delfini Model for Patient Decision-making

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Studies show that physicians tend to describe decisions to patients, but tend to exclude describing benefits, harms, risks, costs, uncertainties and alternatives. Patient-centered care is about choice. Physicians need to be prepared to discuss all these areas with patients.

Studies also show that patients have individual preferences for decision styles depending upon their unique circumstances. These styles are autonomous, physician-directed and shared. Autonomous decision-making is performed solely by the patient. Physician-directed means the physician chooses. Shared decision-making is jointly performed by physicians and patients. Patient-centered care involves the patient in deciding which decision style to use, based on that patient's own needs, values and preferences.

Physicians may wish to favor a more prescriptive style where the evidence is strong. Shared-decision making is often most optimal where there are uncertainties and/or equally reasonable alternatives.

Patient choice is at the heart of patient-centered care.

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