Exploring SDM in HIV nursing care
The process of developing SDM between patients and providers is considered particularly
necessarytopromotepatientempowermentforthemanagementoflong-termconditions.This
approachtocarehasbeenwel establishedinotherdiseaseareas[5].ArecentreviewbyStiggelbout
et al.(p.1173)[6],suggeststhattherearefourclearstepsforSDM:
1.
Theprofessionalinformsthepatientthatadecisionistobemadeandthatthepatient's
opinionisimportant;
2.
Theprofessionalexplainstheoptionsandtheprosandconsofeachrelevantoption;
3.
Theprofessionalandpatientdiscussthepatient'spreferences;theprofessionalsupports
thepatientindeliberation;
4.
Theprofessionalandpatientdiscusspatient'sdecisionalrolepreference,makeordeferthe
decision,anddiscusspossiblefollow-up.
AsHIVmovestowardachronicdiseasemanagementmodel,itisimportanttoensurethatSDM
principlesarealsoembeddedwithinHIVcare[7].ThekeyareaswherepeoplelivingwithHIVface
complexdecisionshavebeendescribedina2010systematicliteraturereviewas:(i)whetherornot
todisclosetheirdiagnosistoothers;(ii)decisionsaboutadherencetotreatments;and(iii)decisions
aboutsexualactivityandparenthood[1].
Theneedforpatientempowermentandforpatientstobeinvolvedindecisionsabouttheir
healthcareisreflectedintheBritishHIVAssociation(BHIVA)Standards of Care for People Living
with HIV[8],particularlyStandards9and10.Standard9suggeststhatpatientsshouldbeinvolved
withintheircareandself-managementastheseapproachescanultimatelyleadtoimprovements
inpatients'qualityoflife.Standard10states,`People living with HIV should be actively involved in
decisions relating to their own care and treatment as they wish'.
TheEuropeanAIDSClinicalSociety(EACS)treatmentguidelinesalsosupportanSDMapproach
[9].Theyadvocateusinga`WEMS'technique(waiting3seconds,echoing,mirroring,summarising)
to assess readiness to start treatment. This technique is similar to motivational interviewing
techniques. This recommendation goes some way to addressing SDM in relation to starting
treatment;however,itdoesnotaddresshowpatientsareinvolvedindecisionsthroughouttherest
oftheirhealthcarejourneyorforhealthissuesotherthantreatmentadherence.
WithintheUK,otherthantheBHIVAStandards of Care[8],therearenosuggestedguidelinesor
resourcesavailabletohelphealthcarepractitionersfacilitateSDMwithinHIVcare.Similarly,whilst
considerableresearchonSDMhasbeenundertakeninotherdiseaseareas[5,10­12],verylittle
researchhasexploredSDMspecificallyinrelationtoHIVcare[13­15].
Thegoalofthisresearchtherefore,wastodeliverinsightsintoSDMwithinHIVcareintheUK,
fromanursingperspective.
2016
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