The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk.
In previous work, the Principal Investigator successfully demonstrated that a video of the goals of care in advanced cancer improved understanding and decision making in a small group of patients with advanced brain cancer. The video presents end-of-life options within the framework of the patient’s primary goals of care (i.e., life prolongation, maintenance of function, or comfort care). Building on this earlier work, the main goal of this study is to conduct a randomized controlled trial of the video decision support tool (vs. a verbal narrative) to test the hypothesis that the video improves the decision-making process among persons with advanced cancer.