that align with their values or determine which course of action will help them reach the desired outcome. Some simple, open-ended sentence stems to help client move past a barrier and express their feelings might include: ● “Let’s talk about what is most important and make list.” ● “What seems best to you … why is it best?” ● “What makes the most sense to you?” ● “Can we talk through your concerns about _____?” ● “Can we talk about what you are thinking about that is keeping you from a decision? ● “There is no rush, we have time to talk this through.” ● “Can we talk through some pros and cons you are thinking about?” ● “Can we come up with a next step?” ● “Do you need more information on ____ or is something unclear?” ● “Do you see a path forward? What does it look like?” ● “What would be the best-case scenario? What would be one step in that direction? Or the next step to move forward?” Counselors must plan and prepare to provide evidence- based information to support the client and guide them through the SDM process. This involves researching the positive and negative components for the courses of action being considered, strategies to clarify values, and assist in weighing “pros and cons” for example. As in all counseling methods, SDM models depend on creating a supporting atmosphere that encourages open expression of feelings, shows empathy, is nonjudgmental, and communicates support for the client’s feeling, concerns, and values. After the decision is made, the counselor will need to guide and assist the client to implement the plan and evaluate the course of action. Assessments on the progress and effectiveness of the course of action should be ongoing and inform future counseling sessions. The client and counselor can work together to adjust or reinforce positive outcomes moving forward. The SHARE Approach: Essential Steps of Shared Decision-Making The Department of Health and Human Services, Agency for Healthcare Quality and Research (AHQR) developed the SHARE Approach to train professional healthcare providers to assist clients in making the best decision about their plan of care. This client-centered approach is designed to engage clients in decisions based on their preferences, needs, and values (AHQR, 2020). The SHARE Approach has five steps to follow with tips for implementation including strategies to use with clients. The following is a brief overview of the model: Essential Steps of Shared Decision-making Step 1: Seek the client’s participation. ● Communicate that a choice exists and invite the client to participate in the process. 1. Summarize the health problem. 2. Ask the client to participate. 3. Include family and caregivers in decisions. 4. Remind the client that his or her participation is important. Step 2: Help the client explore and compare treatment options. ● Discussing options with the client can help build a trusting relationship. ● Assess what the client already knows about his or her options. ● Write down a list of the options and describe them in plain language.
1. Explain each option clearly. 2. Avoid using technical or medical jargon 3. Point out when there are clear differences between specific options 4. Talk about important unasked questions. ● Clearly communicate the risks and benefits of each option in a way that the client can understand. ● Offer positive and negative outcomes. ● Offer evidence-based decision tools whenever possible. ● Use and explain appropriate visual aids (graphs, charts, pictographs) to help patients understand explanations. ● Use the teach-back technique to check for understanding. 1. Ask the client to explain in his or her own words what the options are. 2. Being able to use different approaches, such as Web-based decision aids, printed handouts, or handwritten drawings, will help adapt to the different ways in which people learn and process information. 1. Verbalize uncertainty about the choice or concern about undesired outcomes. 2. Waver between choices. 3. Delay the decision. 4. Question personal values or what is important to them. 5. Be preoccupied with the decision. 6. Show signs of distress or tension. Step 3: Assess the client’s values and preferences. ● Encourage clients to talk about what matters most to him or her. ● Listen actively to the client. ● Show empathy and interest in the effect that a problem is having on the client’s life. ● Acknowledge the values and preferences that matter to the client. ● Agree on what is important to the client. ● Assessing preferences matters, especially when clients defer decisions to clinicians. The counselor should ensure that the dialogue reflects important information about the options (e.g., specific procedures, risks, and benefits) and that a client’s preferences are acknowledged. Step 4: Reach a decision with the client. ● Look for signs of decisional conflict. The client may: ● Help the client move to a decision. Ask if he or she is ready to decide or if they have any additional questions. ● Ask the client if he or she would like additional information tools such as educational materials or decision aids to help decide. ● Check to see if the client needs more time to consider the options or discuss them with others. Schedule another session if the client requests more time to consider the options. ● Confirm the decision with the client when he or she is ready to decide. Ask the client to describe the treatment options and which one he or she chose. ● Verify the next steps to be taken and timing of these actions with the client. ● Schedule follow-up appointments. Step 5: Evaluate the client’s decision. ● Make plans to review the decision in the future. Remind the client that decisions may be reviewed and can be changed if they are not working well. ● Monitor the extent to which the decision is implemented. ● Assist the client to manage barriers to implement the decision.
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Book Code: PCTX1326
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