Formulating and Implementing the Treatment Plan and Evaluation

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Introduction

Step four of the evidence-based practice process encompasses discussing options with the patient. Step five involves the formulation of an agreed-upon treatment plan, step six considers the implementation of this plan and step seven is where you evaluate the effectiveness of the treatment plan. When thinking about the 5 A’s of evidence-based practice, these steps cover the A’s for Apply and Assess.

Important Considerations

Patient-centred approach

“A particular approach to the health-professional – patient relationship that implies communication, partnerships, respect, choice and empowerment, and a focus on the patient rather than their specific clinical condition”

Treating patients with dignity

Quick and effective response to patient needs and concerns

Providing patients with enough information to enable them to make informed decisions about their health care – informed shared decision making

Informed decision making - :”Decisions that are shared by doctor and patient and informed by best evidence. Not only about the risks and benefits, but also the patient-specific characteristics and values. It occurs in a partnership that rests on explicitly acknowledged rights and duties and an expectation of benefit to both.”

Shared-decision making and evidence based practice

The patient is central in evidence based practice, however incorporating patient needs, values and preferences still is lacking. This is where shared decision making steps in. This provides an opportunity for the healthare professional to introduce the evidence into a consultation and then discussing this with the patient. This is necessary so that a patient can construct their own informed preferences. This requires of healthcare professionals to be know what the best available evidence is or to find it, discuss the benefits and harms with patients.

What is NOT shared decision making?

An extra or single step to be added to a consultation

To provide patient education

Simply providing a patient with a decision aid

Presentation of the healthcare professional’s findings and recommendations and asking the patient if they are okat with this

Shared desion making is a process and can sometimes involve sharing of patient education material and decision aids, but it is not dependent on these.

Partnership between healthcare professionals and patients – needs bidirectional communication

Elements of shared decision making can include:

Explanation of problem, condition and why it is necessary to make a decision

Allowing and inviting the patient to engage

Explanation of the options, benefits and harms of each

Exploting patient needs, circumstances, valuses, preferences

Making sure both parties understand each other and sufficient answering of questions

“Engaging in collaborative deliberation and consensus”

Making or deferring of a decision

Approaches to guide decision making

Various approaches , one of which included breaking the decision making process into three parts

Team talk

Option talk

Decision talk Elwyn article

“It is not about who wins in the conversation, or who is right, or whose opinion is being chosen as the winning option in the end. We have to remain professional and remember to put the patient’s values and preferences and goals in the centre of the conversation.” Benita

Read this article When shared decision making and evidence based practice clash

This is real life, each patient is different, there needs to be informed decision making for each situation that you are in.

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