A three-talk model for shared decision making: multistage consultation process

OBJECTIVES\ud To revise an existing three-talk model for learning how\ud to achieve shared decision making, and to consult\ud with relevant stakeholders to update and obtain wider\ud engagement.\ud \ud DESIGN\ud Multistage consultation process.\ud \ud SETTING\ud Key informant group, communities of interest, and\ud survey of clinical specialties.\ud \ud PARTICIPANTS\ud 19 key informants, 153 member responses from\ud multiple communities of interest, and 316 responses\ud to an online survey from medically qualified clinicians\ud from six specialties.\ud \ud RESULTS\ud After extended consultation over three iterations, we\ud revised the three-talk model by making changes to\ud one talk category, adding the need to elicit patient\ud goals, providing a clear set of tasks for each talk\ud category, and adding suggested scripts to illustrate\ud each step. A new three-talk model of shared decision\ud making is proposed, based on “team talk,” “option\ud talk,” and “decision talk,” to depict a process of\ud collaboration and deliberation. Team talk places\ud emphasis on the need to provide support to patients\ud when they are made aware of choices, and to elicit\ud their goals as a means of guiding decision making\ud processes. Option talk refers to the task of comparing\ud alternatives, using risk communication principles.\ud Decision talk refers to the task of arriving at decisions\ud that reflect the informed preferences of patients,\ud guided by the experience and expertise of health\ud professionals.\ud \ud CONCLUSIONS\ud The revised three-talk model of shared decision\ud making depicts conversational steps, initiated by\ud providing support when introducing options, followed\ud by strategies to compare and discuss trade-offs,\ud before deliberation based on informed preferences.