A Guide to Pediatricians’ Conversations: “Choice Talk,” “Options Talk,” and “Decisions Talk”
| Choice talk |
| • Step back |
| o Summarize: “The issue is real. Do you consider it a problem? A major problem?” |
| o What’s next? |
| • Offer choice |
| o “There is some information about this; I’m happy to share what I know.” |
| • Justify choice |
| o Respect preferences: “Treatments have different consequences; some will matter more to you than others; you will need to let me know.” |
| o Uncertainty: “Evidence may be lacking; outcomes vary at the individual level.” |
| • Check reaction: information overload? |
| • Defer closure: “You’ve asked for and I’m happy to give an opinion, but first I wish to be clear …” |
| Options talk |
| • Check knowledge: “What have you read or heard about ______?” |
| • List options |
| o “Before we get into details and decisions, let me go through some options.” |
| o Note: observing and monitoring the child’s present status is always 1 option |
| • Describe options |
| o Using practical terms to ensure understanding |
| o Potential order of treatments; postponement options |
| o Is the intervention reversible? |
| o “Chunks and checking”: clarify re pros/cons, resume and clarify |
| • Provide decision support: informal/formal patient decision aids |
| • Summarize: list out and have patient/family “return” the information |
| Decisions talk |
| • Focus on preferences: “What, from your point of view, matters most?” |
| • Elicit a preference: offer more time to think/offer more guidance |
| • Moving to decision |
| o “Do you have more questions?”; “How would you like to proceed?”; “Do you need more time to think about our decision?” |
| • Offer review: decisions can be revisited; can help with closure |
| Choice talk |
| • Step back |
| o Summarize: “The issue is real. Do you consider it a problem? A major problem?” |
| o What’s next? |
| • Offer choice |
| o “There is some information about this; I’m happy to share what I know.” |
| • Justify choice |
| o Respect preferences: “Treatments have different consequences; some will matter more to you than others; you will need to let me know.” |
| o Uncertainty: “Evidence may be lacking; outcomes vary at the individual level.” |
| • Check reaction: information overload? |
| • Defer closure: “You’ve asked for and I’m happy to give an opinion, but first I wish to be clear …” |
| Options talk |
| • Check knowledge: “What have you read or heard about ______?” |
| • List options |
| o “Before we get into details and decisions, let me go through some options.” |
| o Note: observing and monitoring the child’s present status is always 1 option |
| • Describe options |
| o Using practical terms to ensure understanding |
| o Potential order of treatments; postponement options |
| o Is the intervention reversible? |
| o “Chunks and checking”: clarify re pros/cons, resume and clarify |
| • Provide decision support: informal/formal patient decision aids |
| • Summarize: list out and have patient/family “return” the information |
| Decisions talk |
| • Focus on preferences: “What, from your point of view, matters most?” |
| • Elicit a preference: offer more time to think/offer more guidance |
| • Moving to decision |
| o “Do you have more questions?”; “How would you like to proceed?”; “Do you need more time to think about our decision?” |
| • Offer review: decisions can be revisited; can help with closure |
Modified with permission from Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–1367.