One, two, three, too many… How to conduct shared decision making

Medical | Glyn Elwyn, MD, MSc, FRCGP, PhD | July 18, 2018

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Shared decision making requires that clinicians break down complex processes into simple steps to help patients understand their options. Read this blog post by Glyn Elwyn, MD, MSc, FRCGP, PhD from Dartmouth College and founder of Option Grid.

Whether or not it is true that some cultures don’t have words for amounts greater than three, or, more likely, do not feel the need to overcomplicate things, the concept of three is a helpful memory hook.

And so it is for remembering how to accomplish shared decision making with patients. The three-talk model of shared decision making is a simplified form of a more complex, conceptual framework called collaborative deliberation. It was made simpler because we all need to break down complex processes into simpler steps when we are learning something new. As we become more accomplished, we add nuances, spins, whistles and bells. But first, we need the basics.

The three-talk model of shared decision making is a simplified form of a more complex conceptual framework called collaborative deliberation.

The three-talk model for shared decision making

  • Team Talk; First, make sure you do “team talk,” which is to say, reassure the patients that together you are going to create a team to tackle the task of making the very best decision.
     
  • Option Talk; Second, do “option talk,” where you use the best information that you can get your hands on to explain the most reasonable options that are available, and which need to be compared and discussed. This is the deliberation piece, and where you need to communicate the risks of harms, benefits and trade-offs in ways that patients easily understand.
     
  • Decision Talk; Third, conduct “decision talk,” where as a clinician you invite the patient to tell you how they react to the information you have shared, and where you become deeply curious about what is important to them, and how to arrive at a decision that best fits the patient’s priorities and situation.

Team, option and decision talk. The three-talk model of shared decision making.

Caption: The Three Talk Model outlines three broad steps that form the core elements of shared decision making. Published in the British Medical Journal in 2017, it has been widely cited and used as a basis for teaching shared-decision making techniques.

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Glyn Elwyn, MD, MSc, FRCGP, PhD

Glyn Elwyn, MD, MSc, FRCGP, PhD is a physician-researcher, Professor and Senior Scientist at The Dartmouth Center for Health Care Delivery Science and The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College.

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