- What we know for sure about the context.
- The evidence we have to base this on.
- The information that is missing, but that we can find out (and who will do this research).
- The information that is missing, that we cannot know.
- Develop a shared understanding of the context, including areas
that may be unsettled or controversial.
- Discuss the evidence:
- Is there agreement about the sources of evidence?
- Is there agreement about how this evidence is interpreted?
- Ask specifically if there are any assumptions people believe are
being made that are contentious or unclear and make these explicit.
- Identify the source(s) of the disagreement and if consensus is possible.
Tips for Success
- Ensure that you list beliefs about the world (things that are true or false – often declarative sentences) and not values (what is important to us – often imperatives – “we should”…).
- Remember that reasonable people can understand what reality looks like and how to interpret evidence differently.
- If someone states a belief that is contentious, ask probing questions to understand the source of disagreement.
- Use qualifiers (e.g. sometimes, in most cases) to get to a statement everyone can live with.
- List disagreement about a fact as a fact itself (e.g. there is disagreement amongst the team about the standard of practice.)
- Create subheadings for the facts, if useful.
- Examples include: About the patients and families affected; the system (relevant laws, policies, and processes); the team members involved; the community.
To download the Clinical Decision Process Workup, please click here.