Activity 2.5: Reflective practice

Consider a recent situation where someone in your care was faced with an important decision.

  • Do you think they were well supported in coming to their decision?
  • What efforts were made to provide information, and to gain insight into that person’s opinions?
  • Did the decision properly reflect the person’s values and beliefs?

Shared decision making rests upon an exchange of information, values and beliefs. Healthcare staff do not always have the opportunity to get to know their patients well. It all depends upon the kind of environment they work in. Clearly, it will be more challenging to get to know someone within a fast-turnover environment like an Emergency Department, compared with, say, a ward treating people with more long-term needs, or residents of a nursing home.

Also, consider the context of the decision. There may be a life-threatening situation where the patient is unable to provide consent, e.g. during a collapse, or cardiac arrest. In resuscitation situations, hospital patients should have had their resuscitation status agreed upon, in conjunction with the patient and/or their family, and recorded in their medical notes soon after admission into the hospital. The actions required in other emergencies may not be so clearly defined, and the onus is then upon you to do what you consider to be in the best interest of the patient at the time, and to then be able to reasonably justify your actions.

Clinical decisions made by physicians, particularly those involving formal consent to a procedure, require an open and honest conversation, and exchange of views. Providing the information sufficient and necessary for the patient to come to a decision about their care is vital, but so is listening to their needs, weighing up their system of values and beliefs, and supporting them emotionally as they come to a decision based upon the information in front of them.

They may be improperly swayed by information which is only part of the whole story, or by assumptions based upon imperfect knowledge of conditions of procedures which they already hold. Research has shown that opportunities to correct misconceptions held by patients are not always taken. In some cases, clinicians may even reinforce them, perhaps inadvertently (Hoffmann & Del Mar 2015).

Despite the institutional difficulties which the NHS faces in bringing PCC into its everyday processes, you can make a difference through supporting patients to make informed choices, e.g. in the promotion of self-managed care (Hairon 2008). In most cases, the better the lines of communication, the better the outcomes.