A patient perspective of using evidence for shared decision-making in a medical consultation

Session: 

Oral session: Patient or healthcare consumers involvement and shared decision-making (7)

Date: 

Tuesday 18 September 2018 - 11:00 to 11:10

Location: 

All authors in correct order:

Brown A1
1 No Affiliation, United Kingdom
Presenting author and contact person

Presenting author:

Alistair Brown

Contact person:

Abstract text
Background:
I am a survivor of childhood leukaemia. I had a bone marrow transplant and have experienced multiple complications as result of chemotherapy and radiotherapy treatments. Recently I have had three episodes of spontaneous pneumothorax (collapsed lung) in 14 months. Healthcare consultations are crucial to my well-being but are sometimes unsatisfactory, particularly in evidence-based shared decision-making. I reflect on my experiences and suggest how this might be improved.

My approach:
To ensure my important follow-up appointment with the thoracic surgeon was evidence-based and truly facilitated shared decision-making, I reviewed the most up-to-date evidence on my condition, and sent a letter and one page summary of my main concerns to the surgeon a week before the appointment. I also brought a list of questions. I hoped these two strategies would prepare both me and the surgeon for our discussion.

What happened?
I was seen by another doctor with no knowledge of my background or access to my history, who had not seen either letter or summary. I then briefly spoke with the surgeon, who had received my letter and summary, but the interaction was hurried and limited. The doctors' body language – standing – communicated rush. Therefore it did not seem appropriate to discuss associated mental health issues, or the evidence base. Instead, I ensured all prepared questions were asked and took notes of the answers.

Conclusions:
A list of questions is an essential minimum for important appointments to ensure key information is communicated. A letter and/or summary may help facilitate discussion, however on this occasion any benefit of the letter or summary was lost due to time constraints.

Patient or healthcare consumer involvement:
I am a patient and this is based on my own analysis and reflections.

Relevance to patients and consumers: 

I am a patient. It is important to me that my treatment decisions are based on the best evidence, which is difficult for me to appraise; but as applied to my circumstances and priorities, which only I can appraise. Therefore, evidence-based shared decision-making is an ideal that is difficult to achieve in practice. I would like to discuss why, and my own attempts to achieve it.