Could Linear Shared Decision Making be right for your PMC? If the term shared decision-making is new to you, maybe it’s time to get on board this growing trend and pinnacle in patient-centered health care.
Shared decision making allows patients and their health care providers to work together to make decisions, taking into account the patient’s values and preferences, the best clinical evidence available, thereby empowering patients to select the care paths that are best for them. Does this sound like a valuable process for the PMC?
According to Informed Medical Decisions Foundation, shared decision making involves at least two experts: patients are experts about themselves and what is most important to them, and health care providers are experts in their fields. “Shared decision making is appropriate for any health decision where there is more than one medically reasonable option.”
In recognizing that abortion is legal, if we don’t acknowledge that she sees abortion as a reasonable option, we may add to her stress by pressuring her to choose life.
In any clinical setting, understanding and accepting the freedom the patient has to choose her own path can present a conflict. That conflict is ours to navigate, not hers.
Our experience substantiates that the majority of those we serve, whether considering a medical or surgical abortion, have not considered abortion from a medical standpoint.
So many times the patient can go to the internet and do a search, but that search doesn’t address what the patient’s true needs are. It’s critical that we recognize that our patient may feel abortion is her only choice. She has pressures and needs that are not addressed through searching on line.
We in the PMCs have the opportunity by using shared decision making to draw those pressures and needs out of her. And then, rather than trying to convince or persuade her to follow a particular course of action, we can use our expertise with fetal development, ultrasound, abortion procedures, and how abortion could impact her physically, emotionally, spiritually, not to mention relationships and those around her, to answer the questions and needs she presents.
Then, whether the patient chooses to carry or terminate, it helps the advocate to stay separated. The patient is coming to her own conclusion.
Executive Directors appreciate that they have less compassion fatigue among their staff, because the decision is patient-owned and not worker-owned. They have staff and volunteers who are able to share experiences less from a success or failure perspective and more from an empowered perspective because regardless of the decision the patient chooses, they can know they empowered the women they saw today.
PMCs across the nation have switched from how they had been offering their services to a Linear Shared Decision Making (LSDM) platform. The LSDM platform uses decision tools to facilitate the conversation about the decision(s) the patients face, helping them to identify their preferences, think about what they know and don’t know, and what they need to know before making a decision. By going through this process with a provider, patients are equipped and empowered “to make informed values-based decisions.”
Two Executive Directors and one Center Director whose clinics have transitioned to LSDM with the help of Sparrow Solutions Group shared 9 ways the LSDM platform has helped their PMCs and can improve yours too:
Note: In this article Patient Coordinator refers to what used to be known as Client Advocate. Some quotes have been edited to reflect this change for simplicity and consistency. Some use titles such as Care Coordinator and Patient Advocate.
1. Patient-driven as opposed to agenda-driven. For Ellen Dudney, RN, BSN, ED of Pregnancy Resource Clinic of Clark County in Springfield, OH, this paradigm-shift was critical. As a nurse, she “felt uncomfortable with how we were talking to patients—that we were pushing our agenda on them.” Soon after she became the ED, she talked to Connie, and as a nurse, she felt the LSDM platform lined up better because it empowered the patient to take ownership of her decision.
Jay-Tea Leggett, Center Director of Center for Pregnancy Choices in Jackson, MS, concurred. Robin Fuller, BSW, Executive Director of Pregnancy Care Center in Grants Pass, OR, added that she understood the value of patients making their own decisions based on their values, and explained how the decision guide provides a tool for the “patient to tell us what decisions she faces instead of us trying to manipulate her and telling her what to do.”
2. Consistency. Robin confessed what may be commonplace in many PMCs and PRCs before going linear: “Everyone did their own thing. We didn’t have scripts. We didn’t have specific things that would be said or not be said. One volunteer might be beating someone over the head with the Gospel. It wasn’t all lined out. There were a lot of risks. We had a lot of well-intentioned people doing things that could bring risk to the organization.”
Now that they are linear, Robin described a predetermined process that everyone follows. “As ED, I have to know the staff is consistent in what they’re doing. There are people who have agendas. You have to know how to vet people. It brings confidence to the board knowing that everyone is doing things the same way.”
Consistency was a critical factor for Ellen too. She noted that prior to going linear, “There was not a consistency among the patient coordinators and how situations were handled, and there was no real way to correct that.”
As Jay-Tea put it, “We know what’s getting told. There’s a specific order to how and when you talk about things. Before things could have easily gotten left out or forgotten.”
3. Better use of time. Jay-Tea said they are now able to see the same number of patients in half the time. “With parenting-minded, we aren’t wasting time and effort on things that aren’t applicable. With abortion-minded, it takes a lot less time to see her, yet we’re addressing the issues she has. The decision tools enable us to get to the meat of her situation quicker.”
4. Patient ownership of decisions. Jay-Tea explained, “She uses words that we would never use. Like she’ll write down [as a reason to avoid this option], ‘murdering my own child.’ We would never use that kind of language. But because she’s saying it, because she’s written it down, we get to talk to her about that.”
Robin described how the decision tool compels the patient: “When the patient has to stop long enough to go through a decision tool, it looks different than it might have in her head. 
It slows her down long enough to think clearly.”
Ellen concurred, “The decision guide gives a window to what’s in her heart—what she really feels deep down. Sometimes she still chooses abortion, and we have to accept the decision she makes, but we’ve given her information to look at other options.”
5. Better patient care. Ellen’s background in nursing gives her specialized expertise. “It helps the patient feel more in control of the process, and whenever that happens, she will tend to make a better, informed decision, and will tend to own the decision because she is acting out of knowledge and feeling in control rather than acting out of fear.”
Ellen explained how LSDM “clarified and made it easier to be sure we were following standards of care.” She added how she loves the nursing care plan—having evidence-based goals and objectives for what they’re following.
Robin noted that LSDM “empowers each woman to make decisions that are grounded in fact and belief and in her own belief system instead of fear. It helps remove fear and see clearly a decision-path that she can feel comfortable with.”
Jay-Tea described how prior to transitioning to LSDM, they weren’t doing medical assessments until just before the ultrasound, but now they are doing that on the first visit, whether the patient has an ultrasound on that visit or not. Consequently, they’ve been able to intercede with doctors for patients who may need immediate care that they may not have received before.
6. Eliminate unnecessary work/ streamline everything. Jay-Tea expressed how much their team appreciated Connie asking questions like, “Are you getting information you don’t need? Why are you asking that? What are you going to do with that information?”
She described how Connie encouraged them to think about their methods for everything and how that helped them to connect everything together and determine what they needed for their purposes.
Jay-Tea said that prior to the LSDM training, “We’d been filling in blanks that were given to us and asking questions and for information we didn’t need.” LSDM training helped them determine what they wanted to measure and to only ask questions that pertained to their own measurables.
She said the question they all ask is, “How will we know we’re making a difference?” She said, “We changed our data entry and our forms and our process to only track what we wanted to see– where we were making a difference.”
Along those lines, they also streamlined and limited their literature.
LSDM training teaches staff how to use the shared decision making process to determine which pieces of literature to select based on what the patient shares, and the optimal amount of information to give to a patient to keep from overwhelming her and to make it most likely that she’ll actually read and think about it rather than trash it.
7. More contact with abortion-minded patients. Ellen said that prior to LSDM training, they rarely saw abortion-minded or abortion-determined patients. In fact, most of their visits—probably 70%—were for material or support services rather than medical services. Now, however, 60-70% of their visits are medical and only 30-40% are for support services.
She explained, “We want to see anybody, regardless of their intentions. But if our mission is to share Jesus Christ and His respect for life, it seems that our support services, which were meant to support that mission, actually skewed it.”
Ellen said that a lot of women who need clothes and diapers could get those things from clothing pantries in their area. And she said they still provide diapers and formula for the first year of life, and layettes at delivery.
Additionally, both Jay-Tea and Robin commented on the positive responses they’ve received from abortion-minded patients. Jay-Tea said that they are able to follow up more with them—that they answer the phone, whereas before they might not have.
Robin said that their patient satisfaction surveys are glowing. “Even those abortion-minded love us. Those considering abortion say over and over that they didn’t feel judged. Those who choose abortion come back—for support afterwards or another pregnancy test.”
8. Better equipped patient coordinators. Ellen said, “Patient coordinators feel better equipped and prepared in meeting with an abortion-minded patient. The LSDM process makes it easier for the patient to clarify what her needs are and it equips the patient coordinators to better meet her needs.”
9. Credibility in community. Ellen said transitioning to LSDM has helped her clinic be recognized more in the community as a mainstream medical clinic. She said they’re no longer seen as, “just a group of church ladies down the street saying don’t have an abortion.” Instead, “We’re providing a medical service to a population that wouldn’t be getting that otherwise.”
Ellen also said that having LSDM in place makes it easier to talk with donors and to fill out grant applications—especially ones that are not faith-based.
Robin’s clinic is also AAAHC accredited. She said that linear was a really good step in moving toward accreditation.
Perhaps Robin Fuller best summed up why any PMC might consider a Linear Shared Decision Making platform, “I wanted to lower risk, raise the confidence of my staff, and provide the best help for our patients to make good decisions.”
For your convenience, here are links to other medical resources regarding shared decision making:
https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf
http://www.informedmedicaldecisions.org/shareddecisionmaking.aspx
Reni Bumpas
Sparrow Solutions Consultant
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