EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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COLLABORATIVE CARE 34 FEBRUARY 2019 | EMSWORLD.com H ow often have you completed a refusal of transport but left frustrated and concerned for the patient's well-being? You may have asked yourself, What made this patient so stubborn? Could I have said something different to get them to go to the hospital? In the s e situations the s trateg y of s h a r e d d e ci s i o n - m a k i n g (SD M) c a n improve communication and facilitate m ore ef fec ti ve dis cus sions b et ween prehospital personnel and their patients, leading to care decisions that are more satisfactor y for all. A tenet of EMS Agenda 2050 is to cre- ate a people-centered EMS system. The project's work group suggested this will be achieved when we "understand and address the patient's perspective." SDM is an approach designed to guide pro- viders in connecting with those they aim to treat and seeing things their way. For EMS this may have implications for trans- port, longer-term care, and potentially reim- bursement. What Is Shared Decision- Making? In simplest terms SDM is a process by w hich h ealth c are p rofe s sio nal s an d patients work together to make health- care choices. 1 It is easy to assume this is how all healthcare transactions take place. However, SDM is much more than a physician giving a patient a prognosis and offering a solution to accept or refuse. Instead, SDM is a process of joint delibera- tion through mutual understanding. Others have described SDM a s "an interac ti ve d e cisio n - mak in g p ro ce s s conducted on an equal footing." 2 In this philosophy a healthcare provider takes part in a treatment plan, as opposed to dictating it. SDM requires the provider to tr y to understand the patient's cultural views and beliefs that influence their choices, as well as ensuring the patient comprehends all their options. Equal footing also means providers appreciate patients' autonomy to help direct their own course. When applicable a paramedic must provide all options— this includes alternatives, risks and ben- efits, and possibilities if nothing is done. The patient has the right to express their "values, preferences, and opinions." 3 A s a framework for the healthcare professional, SDM relies on knowledge, available data, and clinical authority to present a comprehensive array of options to patients. The idea is not to hold pre- hospital providers to the same standard By Aaron Florin, MSHS, NRP, SPO HOW SHARED DECISION-MAKING CAN BENEFIT CARE Working with patients on their healthcare choices can lead to greater satisfaction Photo: Aaron Webster

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