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 Care

Patient-centred care is defined as "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.” (Hoffman et al Key considerations to this approach is:

• to treat patients with dignity
• to respond quickly and effectively to patient needs and concerns
• to provide patients with enough information to enable them to make informed decisions about their health care.

This is crucial to informed shared decision making.

Shared Decision-Making

Informed decision making is defined as "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.”

Hoffman et al defines it as follows: "Shared-decision making is a consultation process where a health professional and a patient jointly participate in making a health decision, having discussed the options, their benefits and harms, and considered the patient's values, preferences and circumstances." Hoffman 2014

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 healthcare 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 know what the best available evidence is or to find it, discuss the benefits and harms with patients.

What is NOT shared decision making?

Shared decision-making is NOT (Hofmman 2023):

• 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 okay with this

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

Shared decision-making involves a partnership between the healthcare professionals and patients and requires communication both ways.

Elements of Shared Decision-Making

Elements of shared decision making can include (Hoffman 2023):

• 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 option
• exploring and considering patient needs, circumstances, values, 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

“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

You can read this article When shared decision making and evidence based practice clash to gain insight into how informed decision making is different for each patient and situation.

The Importance of Shared Decision Making

Shared decision making can improve the quality of communication between the healthcare professional and the patient. It is a useful step in knowledge translation as it provides ways to integrate the best available evidence and patient preferences into a health related decision. There are not always one clear treatment option or test to do once the evidence is considered, therefore patient preferences play an important role in shared decision making, in that it is the patient's preference that "should influence the decision on how to proceed." Also, if the patient's preference is acknowledged and incorporated it often leads to better buy-in and compliance of the patient and this can improve the effectiveness of the specific treatment. Shared decision making also provides a way to address patient expectations and be honest and truthful about the benefits and harms of a specific treatment.

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