Coach on Call. Please give me a call if you have more questions about this or other topics.

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1 Coach on Call It was great to talk with you. Thank you for your interest in. I hope you find this tip sheet helpful. Please give me a call if you have more questions about this or other topics. As your UPMC Health Plan health coach, I m ready to help in any way I can. Making an important choice about your health care can be difficult. But being informed about all your options is your right. And choosing wisely with your doctor s help leads to better health. Wondering if you have the right facts can feel scary. Too many opinions or options can be overwhelming. At times you might feel angry or sad just because you have a condition that needs special care. Having these feelings can make a tough decision even harder. The attached worksheet can help you make better health care decisions. It can also help you feel better about the choices you make. The goal is to help you make the best decision for you. If you don t, you may avoid making a decision at all, and your health problem(s) may get worse. Or you might make a decision and then regret your choice or blame others if there are any bad outcomes. Instructions: Review the example on pages 2-7 before you complete the blank worksheet on pages Make some copies of the blank worksheet so you can complete it as many times as you like. A healthier life is life on is the on line the for you! line for you! C UPMC_13_0131 Copyright 2013 UPMC Health Plan, Inc. All rights reserved C ON C MAKING A TOUGH MEDICAL DECISION C (MCG) 08/08/13 PDF

2 Page 2 of 10 Coach on Call Worksheet EXAMPLE Note: In this example, steps 2-5 are shown on separate charts to help you understand each step. Step 1. Spell out the decision. What are you trying to decide? Why? What to do about my knee pain. It s VERY painful to walk. When do you need to decide? I can take my time deciding but the pain is getting worse and worse. Step 2. List your options. What choices do you have? Talk with your doctor, and learn as much as you can about each one. Be sure to ask whether lifestyle changes are an option or could affect the other choices you have. Examples are eating better, being more active, losing weight, stopping smoking, drinking less alcohol, and managing stress. Write down up to four options on the top row of the chart below. Write down any other options on a sheet of paper. Move more on my own (Already taking) Physical therapy (PT) Knee replacement surgery

3 Page 3 of 10 Step 3. List reasons for choosing or not choosing each option. Include the facts, as you understand them at this point. Also think about the things in life that are most important to you. How might each option affect those things? Move more on my own (Already taking) Physical therapy (PT) Knee replacement surgery I d feel better and have more energy. My blood pressure would go down. I d have less pain and stiffness. I worry about making my knee worse. My knees hurt too much to walk or jog. I might not need surgery. It s a longer-term solution. I d be able to get around better with time. Surgery would fix the problem for me. I will get stronger. Lots of people have it done. I would hate driving there three times every week. I might still have a lot of trouble walking. It would really hurt until it heals. I live alone. I d need a lot of help until it heals. I ve never liked to exercise. I ve heard it hurts. I might get an infection.

4 Page 4 of 10 Step 4. Mark each reason with stars to show how much it matters to you. (0 stars = It doesn t matter. 4 stars = It matters a lot.) Move more on my own (Already taking) Physical therapy (PT) Knee replacement surgery I d feel better and have I might not need surgery. more energy. *** **** It s a longer-term solution. My blood pressure would go I d be able to get around Surgery would fix the down. ** better with time. **** problem for me. **** I d have less pain and I will get stronger. *** Lots of people have it done. stiffness. *** **** I worry about making my I would hate driving there knee worse. **** three times every week. *** It would really hurt until it heals. *** My knees hurt too much to I might still have a lot of I live alone. I d need a lot of walk or jog. **** trouble walking. *** help until it heals. **** I ve never liked to exercise. *** I ve heard it hurts. ** I might get an infection. **

5 Page 5 of 10 Step 5. Circle the reasons that are most likely to happen. Ask your doctor. Your UPMC Health Plan health coach can help you too. Move more on my own (Already taking) Physical therapy (PT) Knee replacement surgery I d feel better and have I might not need surgery. more energy. *** **** It s a longer-term solution. My blood pressure would go I d be able to get around Surgery would fix the down. ** better with time. **** problem for me. **** I d have less pain and I will get stronger. *** Lots of people have it done. stiffness. *** **** I worry about making my I would hate driving there knee worse. **** three times every week. *** It would really hurt until it heals. *** My knees hurt too much to I might still have a lot of I live alone. I d need a lot of walk or jog. **** trouble walking. *** help until it heals. **** I ve never liked to exercise. *** I ve heard it hurts. ** I might get an infection. **

6 Page 6 of 10 Step 6. Think about what else you need to do, to help you make the decision. Check what applies to you below. Sort through what other people think. Fill in the chart below. Name, relationship What option(s) do they prefer? Is this person pressuring you? How? How might this person support or not support you? Include support during and after your decision. Son Bill PT Against surgery My son thinks surgery should be the last resort. He lives out of town but would help me with PT costs. Daughter Lea Just wants the best for me No pressure She would be very kind, no matter what I. She would help me at home after surgery and can help with rides to PT. Dr. Wilson, surgeon Surgery For surgery She s a highly rated surgeon. She would not be working with me after surgery, but would refer me for care. Focus on the person or persons who matter the most to you:. My children What do they think is best? Do they disagree with each other or with you? Take turns listening to what matters to each person. Find areas of agreement. Where people disagree about facts, get more information. Ask someone you trust to listen to you and to the others involved, but not give advice. Who do you want to make the decision? I want to make it on my own. I want to share the decision with My children. I want to decide myself after I hear what think(s). I want to ask this person to decide for me:. Get more facts. Find out more about your health problem and what causes it. Correct any facts you may have wrong. Add any that you missed. Include costs, risks, benefits, and outcomes. Learn how your health status and other medical conditions may affect the risks, benefits, and outcomes. Learn how any lifestyle changes such as losing weight or being more active might affect your options and outcomes. Get an opinion from one or more other doctors and/or a specialist.

7 Page 7 of 10 Understand better what matters most to you (your values). Look at the stars you marked on the chart. Think about what they mean to you. Talk to someone supportive about what matters to you. Ask them to listen without giving advice. Talk to people or read stories about people who have chosen each option. What was it like for them? Get more support. Talk with someone you trust. Examples: a counselor, friend, family member Find out where you could get the practical help you would need. Examples: child care, transportation, home delivery Step 7. Make a plan to do one or two of the things you checked above. Be specific. On Tuesday I ll call my cousin in Florida who had the same knee problem to see what worked for her. On Wednesday I ll call my doctor and ask how my asthma might affect my options. Step 8. Follow your plan. Then list your options again and your reasons for choosing or not choosing each one. Include any new options and all you have learned by completing steps 1-7. Move more on my own (Already taking) Physical therapy (PT) Knee replacement surgery After my knee is doing better, it would really help with stiffness. My son said he d help me with the costs. It would even help my asthma. After some PT, I d be able to move more on my own. I think water aerobics would be fun. My friend Gwen loves it. My daughter would help me with rides. There s a lot of hard work involved in recovering. My son thinks it should be a last resort. What s the next step? Write your thoughts here: I m ready to talk with my doctor about starting physical therapy. When my knee is doing better, I ll talk with my health coach about water aerobics..

8 Page 8 of 10 Coach on Call Worksheet Step 1. Spell out the decision. What are you trying to decide? Why? When do you need to decide? Step 2. List your options. What choices do you have? Talk with your doctor, and learn as much as you can about each one. Be sure to ask whether lifestyle changes are an option, or could affect the other choices you have. Examples are eating better, being more active, losing weight, stopping smoking, drinking less alcohol, and managing stress. Write down up to four options on the top row of the chart below. Write down any other options on a sheet of paper. Step 3. List reasons for choosing or not choosing each option. Include the facts, as you understand them at this point. Also think about the things in life that are most important to you. How might each option affect those things? Step 4. Mark each reason with stars to show much it matters to you. (0 stars = It doesn t matter. 4 stars = It matters a lot.) Step 5. Circle the reasons that are most likely to happen. Ask your doctor and UPMC Health Plan health coach for help.

9 Page 9 of 10 Step 6. Think about what else you need to do, to help you make the decision. Check what applies to you below. Sort through what other people think. Fill in the chart below. Name, relationship What option(s) do they prefer? Is this person pressuring you? How? How might this person support or not support you? Include support during and after your decision. Focus on the person or persons who matter the most to you:. What do they think is best? Do they disagree with each other or with you? Take turns listening to what matters to each person. Find areas of agreement. Where people disagree about facts, get more information. Ask someone you trust to listen to you and to the others involved, but not give advice. Who do you want to make the decision? I want to make it on my own. I want to share the decision with. I want to decide myself after I hear what think(s). I want to ask this person to decide for me:. Get more facts. Find out more about your health problem and what causes it. Correct any facts you may have wrong. Add any that you missed. Include costs, risks, benefits, and outcomes. Learn how your health status and other medical conditions may affect the risks, benefits, and outcomes. Learn how any lifestyle changes such as losing weight or being more active might affect your options and outcomes. Get an opinion from one or more other doctors and/or a specialist.

10 Page 10 of 10 Understand better what matters most to you (your values). Look at the stars you marked on the chart. Think about what they mean to you. Talk to someone supportive about what matters to you. Ask them to listen without giving advice. Talk to people or read stories about people who have chosen each option. What was it like for them? Get more support. Talk with someone you trust. Examples: a counselor, friend, family member Find out where you could get the practical help you would need. Examples: child care, transportation, home delivery Step 7. Make a plan to do one or two of the things you checked above. Be specific. Step 8. Follow your plan. Then list your options again and your reasons for choosing or not choosing each one. Include any new options and all you have learned by completing steps 1-7. What s the next step? Write your thoughts here:. This tip sheet is based on the Ottowa Personal Decision Guide. See Accessed 1/27/13