● Choice talk refers to the step of making sure that clients know that reasonable options are available. This is a planning phase and includes the following components: ○ Step back. ○ Offer choice. ○ Justify choice. ○ Check reaction. ○ Defer closure. ● Option talk refers to providing more detailed information about options: ○ Check knowledge. ○ List options. ○ Describe options. ○ Discuss risks and benefits. ○ Provide decision support. ○ Summarize. ● Decision talk refers to supporting the work of considering preferences and deciding what is best: ○ Focus on preferences. Clients will need time to study new information and to consider their personal preferences, particularly for topics that new to them or that they have not experienced. Recognizing this need, and allowing time for it, is a cornerstone for effective SDM (Elwyn et al, 2012). The model also includes the use of decision support tools to provide information in formats that are accessible to patients, using the most up to date evidence about the risks and the benefits of proposed options. Some tools include formats, such as in brief text or diagrams, booklets, websites, videos, and DVDs (Elwyn et al, 2012). The term “deliberation” describes the process of ○ Elicit a preference. ○ Move to a decision. ○ Offer a review (Elwyn et al, 2012). considering information about the pros and cons of their options to consider a range of possibilities. At this stage, clients work collaboratively with professionals as well as other health providers in the integrated team. The deliberation begins as soon as options have been described and understood (Elwyn et al, 2012). This model builds on a foundation of ethical standards that clients be informed of all procedures, give consent, have right of refusal, maintain open and ongoing communication with clients, and the SDM model encourages autonomy and client centered practice. 5. Seek consultation from more than one source to gain multiple perspectives on the dilemma. 6. Brainstorm various courses of action. 7. Enumerate consequences of various decisions. 8. Implement the course of action. After implementation the practitioner should access the outcome of the action taken to determine if it has successfully resolved the issue. If not the model may be revisited and other options may be implemented and accessed.
SDM recognizes the need to support autonomy by building good relationships, respecting both individual competence and interdependence on others (Elwyn et al, 2012). In addition this model advances the concept of informed consent beyond the level of simply understanding the components of treatment where the client is a passive participant in the process. Instead, the client is informed and encouraged to communicate preferences and informed decisions. The NIH stresses the importance of clinical practice that balances these principles with those of beneficence and ethical practice standards. This process includes educating clients about their health care needs as well as the massage and bodywork modalities that are appropriate options for them. This process will help to address low health literacy that is often a barrier to autonomy among clients. For the SDM model to be affective it must be built on the fundamental skills of communication to build trust and openness to consult with the practitioner on all phases of their care and treatment plan. SDM is based on 1) providing information and 2) supporting the decision making process. Providing information Providing Information involves the following (Elwyn et al, 2012): Providing high quality information to clients. We also need to elicit what patients already know, and whether it is correct. If patients are not informed, they will be unable to assess ‘what it is important to them’, and so establish informed preferences. ● Ensure that individuals are not making decisions when insufficiently informed about key issues Supporting deliberation The second task is to support patients to deliberate about their options by exploring their reactions to information. When offered a role in decisions, some clients feel surprised, unsettled by the offer of options and uncertainty about what might be best. If all responsibility for decision making is transferred to patients, they may feel abandoned. Some clients initially decline all responsibility in decision making, and are to participate. There are three key steps of SDM for clinical practice including choice talk, option talk and decision talk, and the clinician supports deliberation throughout the process: Ethical decision making If a practitioner identifies a potential ethical dilemma is developing they may choose to implement a decision making model to investigate the situation and determine a course of action. The decision making model that is used most frequently and complements most of the professional codes of ethics is an eight-step model (Corey et al, 2015). The eight steps are: 1. Identify the problem or dilemma. 2. Identify the potential issues. 3. Look at relevant codes of ethics for general guidance. 4. Consider applicable laws and regulations, and determine how they may have bearing on an ethical dilemma. Treating minors According to the AMTA, a number of studies have been done concerning the effectiveness of massage therapy for younger populations including infants (Armstrong, 2016). These studies have demonstrated that massage and body work for minors is appropriate and effective. For scientific and medical research citations on the efficacy of infant
massage, please see AMTA’s Massage Information Center on their website listed on the reference page. When working with minors, a signed consent form from the parent or guardian, along with permission to provide massage therapy is required. This consent should include a detailed description of the proposed treatment plan and
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