Curriculum standards
Entrustable Professional Activities
LG9: Shared decision making with patients and carers
Shared decision making with patients and carers
Formulate agreed management plans with patients that fit with their medical context, goals, and values
This activity requires the ability to:
- select a suitable context, and include family and/or carers and other team members
- adopt a patient-centred perspective, including adjusting for cognition, disability, cultural perspectives, and language of choice
- select and use appropriate modalities and communication strategies
- structure conversations intentionally
- negotiate mutually agreed management plans, considering the individual patient’s values, goals, and preferred level of involvement in decision-making
- verify patients’, family members’, or carers’ understanding of information conveyed
- develop and implement plans for ensuring actions occur
- ensure conversations are documented and made available to relevant members of the treating team
Professional practice framework domain
Medical expertise
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- recognise that individual patients have different levels of engagement in their health care, and tailor approaches accordingly
- determine patients’ preference for the level of involvement in medical decision-making
- anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors
- seek to understand the concerns, values, and goals of patients, and plan management in partnership with them
- negotiate initial plans and any changes with patients and colleagues
- estimate and express benefit and risks of clinical interventions in individual patients
- inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
- provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
- use and communicate health education resources available to the general population
- recognise and work constructively with patients seeking information from additional sources
- identify and manage barriers to communication, such as language, cultural background, cognitive impairment, speech and hearing problems, capacity, and health literacy issues
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- apply knowledge of the scientific basis of health and disease to the management of patients
- demonstrate awareness of the clinical problem being discussed
- formulate management plans in partnership with patients
Communication
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- use shared-decision making strategies such as ‘ask, tell, ask’, ‘SHARE’, or ‘three-talk method’
- use appropriate communication strategies and modalities for communication, such as emails, face-to-face, or phone calls
- elicit patients’ views, concerns, and preferences, promoting rapport
- provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
- encourage questions, and answer them thoroughly
- ask patients to share their understanding, questions, key health issues, and goals of care
- incorporate appropriate LGBTQIA+ safe language, including gender affirming language
- translate measures of harm and risk into meaningful concepts for patients
- employ communication strategies appropriate for younger patients
- recognise the role of family or carers, and, when appropriate, encourage patients to involve family or carers in decisions about their care
- convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
- use decision aids that assist patients to conceptualise treatment benefits and harms during informed consent
- check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- select appropriate modes of communication
- engage patients in discussions, avoiding the use of jargon
- check patients’ understanding of information
- adapt communication style in response to patients’ age, developmental level, and cognitive, physical, cultural, socioeconomic, and situational factors
- collaborate with patient liaison officers as required
- demonstrate effective consultation skills, including effective verbal and nonverbal interpersonal skills
Quality and safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- perform decision-specific capacity assessments, and be aware of local policies and procedures related to consent and substitute decision makers
- discuss with patients their condition and the available management options, including potential benefits and harms
- provide information to patients in a way they can understand before asking for their consent
- recognise and take precautions where patients may be vulnerable, such as issues of child protection, self-harm, or elder abuse
- participate in processes to manage patients’ complaints
- encourage and work constructively with patient feedback
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- inform patients of the material risks associated with proposed management plans
- treat information about patients as confidential
Teaching and learning
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- discuss the aetiology of diseases, and explain the purpose, nature, and extent of the assessments to be conducted
- obtain informed consent or other valid authority before involving patients in teaching
- value the important role of patients as teachers, and prepare patients for their role in teaching
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- respond appropriately to information sourced by patients, and to patients’ knowledge regarding their condition
Research
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- communicate numeric estimates of benefit and harm to patients in a manner they can understand and act upon
- provide information to patients that is based on guidelines issued by the National Health and Medical Research Council and/or Health Research Council of New Zealand
- provide information to patients in a way they can understand before asking for their consent to participate in research
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- refer to evidence-based clinical guidelines
- demonstrate awareness of the limitations of the evidence and the challenges of applying research in daily practice
Cultural safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- demonstrate effective and culturally safe communication with Aboriginal and Torres Strait Islander peoples and Māori
- demonstrate awareness of appropriate models of care for Aboriginal and Torres Strait Islander peoples, Māori, Pacific peoples and other groups, and how these may inform shared decision-making approaches
- communicate effectively with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
- use qualified language interpreters or cultural interpreters to help meet patients’ communication needs
- provide plain language and culturally appropriate written materials to patients when possible
- negotiate health care decisions in a culturally safe way
- interact respectfully with pastoral care workers and representatives of religion
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- identify when to use interpreters
- allow enough time for communication across linguistic and cultural barriers
Ethics and professional behaviour
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- encourage and support patients to be well informed about their health, and to use information wisely when they make decisions
- encourage and support patients in caring for themselves and managing their health
- demonstrate respectful professional relationships with patients
- prioritise honesty, patients’ welfare, and community benefit above self-interest
- develop a high standard of personal conduct, consistent with professional and community expectations
- support patients’ rights to seek second opinions
- offer apologies or explanations when required
- respect patient autonomy, even if a decision appears unwise or different to the medical opinion
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- respect the preferences of patients
- communicate appropriately, consistent with the context, and respect patients’ needs and preferences
- maximise patient autonomy, and support their decision making
- avoid sexual, intimate, and/or financial relationships with patients
- demonstrate a caring attitude towards patients
- respect patients, including protecting their rights to privacy and confidentiality
- behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours or the illness itself
- use social media ethically and according to legal obligations to protect patients’ confidentiality and privacy
Judgement and decision making
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- determine patients’ level of understanding and commitment to agreed care decisions
- determine the level of health literacy of individual patients, and their willingness to assume responsibility for care decisions
- consider the consequences of decisions, including the decision to do nothing, and the impact on patients and their carers
- recognise own limitations and seek help, when required, in an appropriate way
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- weigh up various treatment choices and explain these to patients and their carers
- inadequately consult with senior colleagues
Leadership, management, and teamwork
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- communicate effectively with team members involved in patients’ care, and with patients
- discuss medical assessments, treatment plans, and investigations with patients and primary care teams, working collaboratively with all
- discuss patients’ care needs with healthcare team members to align them with appropriate resources
- facilitate an environment in which all team members and patients feel they can contribute and their opinion is valued
- involve patients and carers in multidisciplinary team discussions
- communicate accurately and succinctly, and motivate others on the healthcare team
- work constructively with patient support services
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- answer questions from team members
- summarise, clarify, and communicate responsibilities of healthcare team members
- keep healthcare team members focused on patient outcomes
Health policy, systems, and advocacy
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- promote healthy lifestyles for patients and the wider community
- collaborate with other services, such as community health centres and consumer organisations, to help patients navigate the healthcare system
- demonstrate awareness of equity determinants and how these may impact on shared decision making
- be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- communicate with and involve other health professionals as appropriate