Respecting Choices® (RC) offers a system for person-centered decision making that transforms the healthcare culture. Successful implementation of this system has occurred in healthcare organizations around the world. This systematic program includes a staged approach to planning called First Steps® (FS), Next Steps (NS), and Last Steps® (LS) advance care planning (ACP) that recognizes the planning needs of individuals will change over time as illness progresses and goals of care are redefined.
A central component of our person-centered decision-making approach is the role of the physician/provider in assisting individuals to make treatment decisions that align with their goals and values, i.e., what matters most.
The Shared Decision Making in Serious Illness (SDMSI) Curriculum is intended for physicians and other providers caring for patients with serious illness and their families. This 5.5-hour competency based curriculum is divided into Module 1 (Discerning What Matters Most to Patients) and Module 2 (Aligning Treatment with What Matters Most to Patients) which can be offered together in one session, or in two sequential sessions. The course objectives are:
- Define the importance of shared decision making for patients with serious illness.
- Identify communication skills that impact shared decision-making conversations.
- Identify shared decision-making skills to discern what matters most to patients with serious illness.
- Identify shared decision-making skills to align care with what matters most to patients.
- Participate in practice activities to integrate these shared decision-making skills.
- Identify organizational practices to document the elements of shared decision-making conversations.
Through discussion, video examples, and role-play application using a semi-structured interview guide, participants learn the shared decision-making skills to: 1) discern what matters most and 2) align any treatment decision with the person’s goals and values.
Benefits to Patients, Providers, and Healthcare System
- Provides professional development for physicians/providers to enhance their communication skills in facilitating person-centered, shared decision-making conversations with patients with serious illness and their families.
- Provides a shared decision-making approach to assist physicians/providers in aligning treatment with patients’ goals and values, i.e., what matters most.
- Improves physicians’/providers’ skills in assisting patients with serious illness to reflect on their goals and values when navigating treatment decisions, ensuring timely and appropriate referrals that serve to safeguard patients’ decisions are respected, including those for less aggressive treatment.
- Improves communication and documentation of a patient’s goals of care and rationale for treatment decisions, providing direction for all members of the patient’s care team to use in delivering person-centered care and assisting with any treatment decision.
- Decreases physicians’/providers’ and other clinicians’ moral distress and uncertainty when caring for patients with serious illness, as patient goals of care are identified and used to provide direction for care and treatment.
- Defines the role of the physician/provider within the organization’s existing ACP program, and more specifically, how this role aligns with the RC FS, NS, and LS stages of planning. [Note: This curriculum is designed to also be used in organizations that do not use the RC stages of planning.]
- Improves patient and family satisfaction with physician/provider communication and person-centered care.
Download this overview of the SDMSI curriculum.
Comments from Past Participants of the SDMSI Course
“Even more than giving me new skills, this course changed my attitude; I think entirely differently about what patients need in helping them to make decisions.”
“I’m not a general fan of scripting. I’m used to tailoring things to fit my style. But this script is like using a personal trainer – they can get more out of you than if you do it alone; it really helps you get to the heart of the issue much more efficiently.”
“I have used the decision-making framework on more than end-of-life issues; it worked well for using a patient’s goals to drive a decision of whether to begin anti-coagulation in a high-risk patient.”
“Having these conversations is so rewarding; it is the antidote for burnout.”
“Wow, I wasn’t even aware of some of the biases I carry into conversations!”