Entrustable Professional Activities

LG9: Shared decision making with patients and carers

Learning Goal 9

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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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

confident
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

direction
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