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Research
Welcome to the Informed Medical Decisions Foundation library of studies, articles and research overviews related to the topic areas we care about most. In our collection you will find the following resources:
- Shared Decision-Making® Program Research: These studies evaluate and test our suite of decision aids.
- Featured Shared Decision Making Publications: This resource includes key articles and studies that provide insight into the best methods of informing and engaging patients and how doing so can help improve the quality of health care.
- Foundation Perspectives: These succinct white papers, written by our senior scientific advisor, Floyd J. Fowler, PhD, look at common questions about the shared decision making process and provide our best answers based on the current available research.
- Funded Research: Each year, the Foundation funds research that evaluates various aspects of medical decision making. Summaries of these projects are included in this resource collection. Learn more about applying for funding.
Our Library
Below you will find samples of our most recent acquisitions, grouped by resource type.
Shared Decision Making to Improve Care and Reduce Costs
January 3, 2013
A sleeper provision of the Affordable Care Act (ACA) encourages greater use of shared decision making in health care. For many health situations in which there's not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients' preferences and values. One way to implement this approach is by using patient decision aids -- written materials, videos, or interactive electronic presentations designed to inform patients and their families about care options; each option's outcomes, including benefits and possible side effects; the health care team's skills; and costs. Shared decision making has the potential to provide numerous benefits for patients, clinicians, and the health care system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and great alignment of care with patients' values.… Continue reading
Posted in Cost, Decision Aid Effectiveness, Health Care Policy, Patient Decision Aids, Patient Preferences, SDM Implementation
Tagged ACA, CMS, Cochrane Collaborative, decision aids, Group Health, health care costs, HHS, IOM, IPDAS, Medicare, NEJM, PCORI, practice variation, shared decision making
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Communicating with Patients on Health Care Evidence
September 25, 2012
This discussion paper argues for the increased use of shared decision making practices, citing that patients want to be involved in evidence and decisions, that there is a gap between this and what patients get, and that patient satisfaction is linked to shared decision making. These conclusions were reached through research in three stages: environmental scan, qualitative interviews and focus groups, and quantitative survey.… Continue reading
Introducing Decision Aids at Group Health was Linked to Sharply Lower Hip and Knee Surgery Rates and Costs
September 4, 2012
An observational study reporting the changes in surgical rates and costs in the first eighteen months following the start of a program to introduce decision aids for hip and knee osteoarthritis in the Group Health system. They found a 38% reduction in knee surgeries and a 26% reduction in hip surgeries; findings consistent with results from randomized studies of decision aids.… Continue reading
Building Patient-Centeredness in the Real World: The Engaged Patient and the Accountable Care Organization
May 30, 2012
The accountable care organization began life as a catchphrase signifying a shift in the relationship between a hospital and its doctors. By forming an ACO, a hospital and medical staff shared clinical and financial responsibility for coordinating care to improve quality and lower costs. The patient's role was essentially passive, like a car door that ends up with fewer dents and nicks thanks to better management of the auto assembly line. … Continue reading
Patients' Preferences Matter: Stop the Silent Misdiagnosis
May 29, 2012
Many doctors aspire to excellence in diagnosing disease. Far fewer, unfortunately, aspire to the same standards of excellence in diagnosing what patients want. In fact, we will present an accumulation of evidence which shows that preference misdiagnoses are commonplace. In part, this is because doctors are rarely made aware that they have made a preference misdiagnosis. It is the silent misdiagnosis.… Continue reading
Shared Decision Making: A Model for Clinical Practice
May 23, 2012
The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk.… Continue reading
A Multicentre Randomised Controlled Trial Assessing the Costs and Benefits of Using Structured Information and Analysis of Women's Preferences in the Management of Menorrhagia
May 14, 2012
Objectives To develop decision aids to provide evidence-based information and formal preference elicitation for women with menorrhagia; and to evaluate their effects on patient outcomes, patient management and cost effectiveness.… Continue reading
Patient Engagement -- What Works?
April 5, 2012
The author discusses the recent focus on the need for patient engagement in health care, specifically the need for patients to play an active role in their own health care. Patients should be fully informed about their health care and work with their provider to make the decision that is right for them. The author discusses how health literacy, shared decision making and quality improvement are all related to the concept of patient engagement. The author also focuses on evidence in support of interventions designed to engage patients in their health care.… Continue reading
Shared Decision Making: Informing and Involving Patients to Do the Right Thing in Health Care
April 5, 2012
The author discusses the concept of preference-sensitive decisions, that is, decisions where multiple reasonable options exist, and how a shared decision making process is critical to addressing this specific area of medical decisions. The article also looks at patient decision aids and how these educational tools can complement shared decision making by making the practice of high-quality medical care both more effective and more efficient. Lastly, the author discusses the role of shared decision making in state and federal policy and how this legislation can assist in making shared decision making a routine practice in medical care.… Continue reading
Shared Decision Making: Advancing Patient-Centered Care through State and Federal Implementation
March 22, 2012
This comprehensive report builds upon the National Academy for State Health Policy's analysis of state health improvement initiatives and discusses the process and potential of shared decision making in state legislation. The authors examine the legislative and regulatory approaches in Maine, Minnesota, Oregon, Vermont and Washington. The report provides examples of implementation challenges and strategies, as well as lessons learned from the experience. … Continue reading
Posted in Health Care Policy, SDM Implementation
Tagged health care, NASHP, patient-centered care, policy, shared decision making
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Putting Patients First
March 16, 2012
In response to the National Institute for Health and Clinical Excellence's (NICE) guidelines on patient experience quality standards, the authors aim to provide an overview of the guidance. This editorial discusses key points of the NICE guidelines, as well as the benefits of implementation and the challenges that remain. … Continue reading
Posted in SDM Implementation
Tagged Angela Coulter, health care, NHS, NICE, patient experience, patient-centered care, shared decision making, UK
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Decision-Making Process Reported by Medicare Patients Who Had Coronary Artery Stenting or Surgery for Prostate Cancer
March 7, 2012
The objective of this study was to learn how decisions were made for two major preference-sensitive interventions: prostate cancer surgery and coronary artery stenting. Through a mail survey of probability samples of patients who underwent these two procedures, the authors found that while prostate cancer surgery patients reported more involvement in the decision making process than elective stent patients, both reports illustrated the need for increased efforts to inform and involve patients facing preference-sensitive intervention decisions.… Continue reading
Posted in Decision Quality, Patient Knowledge
Tagged decision-making, Floyd J. Fowler, prostate cancer surgery, stenting
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Patient Decision Aids in Knee Replacement Surgery
March 5, 2012
This article discusses the use of patient decision aids in routine clinical practice for patients considering knee replacement surgery. The decision surrounding a diagnosis of knee osteoarthritis is an example of a preference-sensitive decision, meaning there is more than one viable option. Unfortunately, when patients are not fully informed, they are often unsatisfied with the outcome due to unrealistic expectations and a lack of understanding of the potential benefits and harms. The authors describe how implementation of patient decision aids, to support a shared decision making process, may address these issues and improve patient satisfaction, specifically in the context of knee replacement surgery.… Continue reading
Shared Decision Making -- The Pinnacle of Patient-Centered Care
March 1, 2012
This short article outlines the history of patient-centered care, the importance of involving patients in decisions where there is more than one reasonable option and the practice of shared decision making, and argues for their increased use.… Continue reading
One Man at a Time -- Resolving the PSA Controversy
November 24, 2011
Who should decide about screening for prostate cancer: expert panels of clinicians and methodologists, primary care clinicians, specialists, or fully informed patients themselves? The U.S. Preventive Services Task Force recently released a draft recommendation on screening for prostate cancer, designed for primary care physicians and health systems, and has opened if for public comment until November 8, 2011.… Continue reading
Uninformed Compliance or Informed Choice? A Needed Shift in our Approach to Cancer Screening
November 21, 2011
This commentary article criticizes the current practice in health care to conduct cancer screening without first informing patients about the benefits and harms of screening tests. Stefanek believes that the lack of transparent presentation of data about known harms and benefits has resulted in a bias towards screening and an inflated view of how much the reduction in cancer mortality can be attributed to cancer screening overall. Stefanek proposes that effort should be refocused on educating rather than persuading the public.… Continue reading
Posted in Decision Quality, Patient Knowledge
Tagged cancer, health education, shared decision making
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Helping Pregnant Women Make Better Decisions: A Systematic Review of the Benefits of Patient Decision Aids in Obstetrics
October 16, 2011
Objectives: Patient decision aids can be used to support pregnant women engaging in shared decisions, but little is known about their effects in obstetrics. The authors aimed to evaluate the effects of patient decision aids designed for pregnant women on clinical and psychosocial outcomes. Conclusions: Patient decision aids have the potential to improve obstetric care. However, currently the evidence base is limited by the small number of studies, the quality of the studies and because they involved heterogeneous decision aids, patient groups and outcomes.… Continue reading
Posted in Decision Aid Effectiveness, Patient Decision Aids, Patient Involvement, Patient Preferences, SDM in Maternity Care, Special Populations
Tagged BMJ, decision aids, decision support, decision-making, evidence-based medicine, external cephalic version, labour analgesia, obstetrics, pregnancy, pregnant women, shared decision making, women
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Consumer and Provider Perspectives on Shared Decision Making: A Systematic Review of the Peer-Reviewed Literature
September 1, 2011
This brief article summarizes a systematic review of peer-reviewed literature that assesses current consumer and provider perspectives on the process. Both consumers and providers’ attitude towards SDM was more likely to be positive than negative, whereas engagement was somewhat more likely to be lower than higher. The authors conclude that actual engagement in SDM behavior is lagging behind attitudes toward the process and recommend implementation of policies that support SDM.… Continue reading
Policy Options to Encourage Patient-Physician Shared Decision Making
September 1, 2011
This brief provides an overview of the basic tenets of SDM, the challenges of participating in SDM from the provider and patient perspective, and opportunities to adopt SDM in health reform. It contains a helpful review of numerous policy options that could be used to encourage adoption of SDM, including incorporating SDM into meaningful use criteria for electronic health records. Though these options are not state-specific, they could be applied to state policy.… Continue reading
Making Shared Decision-Making A Reality
July 28, 2011
This short book outlines the importance of strong communication skills and illustrates how health care providers might using shared decision making in their consultations with patients. Inspired by Secretary of State for Health, Andrew Lansley's phrase "nothing about me, without me," the authors aim to expand on the meaning of Lansley's vision. The authors define the term "shared decision making", provide examples of skills necessary to implement this process and outline actions necessary to make this vision a reality. … Continue reading
Implementing Shared Decision Making in the UK
April 29, 2011
What about policy regarding SDM? SDM is on the national policy agenda and has been prioritised as part of the health reform bill currently going through the Houses of Parliament. The NHS Constitution emphasises patients' right to be involved in decisions and this is reinforced in standards set by professional regulators. What about tools - Decision support for patients? The UK governments have invested in patient information and a few decision aids are freely available on public websites.… Continue reading
Posted in Health Care Policy, SDM Implementation
Tagged Angela Coulter, decision aids, Glyn Elwyn, health care, health care policy, NHS, shared decision making, UK
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Shared Decision Making in the United States: Policy and Implementation Activity on Multiple Fronts
April 29, 2011
This article reviews the status of SDM implementation in the U.S., including state and federal activity, research funding and implementation in clinical practice. Also included is a helpful list of organizations that are advocating SDM use in the US, professional and accreditation organization activity in SDM, and a list of current activity in the development of patient decision aids.… Continue reading
Posted in Health Care Policy
Tagged Benjamin Moulton, Carrie Levin, decision aids, policy, Richard Wexler, shared decision making
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Informing and Involving Patients to Improve the Quality of Medical Decisions
April 6, 2011
This article describes the current issues surrounding informed patient decision making and how the use of SDM might improve informed decision making. The authors suggest using health information technology to bolster the use and simplify the implementation of SDM, by using it to trigger the delivery of information and collect and store information. The authors also suggest the use of additional surveys to assess patients’ knowledge and goals. The article reviews public and private developments that could facilitate the development of tools and methods to improve patient-centered care. Finally, the authors review policy options for implementation of SDM.… Continue reading
The Potential of Shared Decision Making to Reduce Health Disparities
March 1, 2011
This article explores evidence that shared decision making can help reduce health disparities by improving patient activation and health outcomes, even for patients with lower health literacy. The authors suggest this is imperative since previous research shows that despite lower knowledge scores, patients with less education and income felt extremely well informed with respect to medication and screening decisions.… Continue reading
Posted in Risk Communication
Tagged Benjamin Moulton, health disparities, health literacy, shared decision making
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Do Patients Want a Choice and Does it Work?
October 14, 2010
Nothing about me without me was the guiding principle adopted by 64 participants from 29 countries at a 1998 Salzburg Global Seminar convened to develop ideas for improving the quality of health care by involving patients. The catchphrase has now resurfaced in the coalition governments new plan for the NHS in England, which sees patient choice and shared decision making as key mechanisms to create a patient centred and quality focused NHS.… Continue reading
A Randomized Trial of a Telephone Care-Management Strategy
September 1, 2010
This article reviews a research study where patients with selected medical conditions and predicted high health care costs were given telephone-based care-management coaching to instruct them about SDM, self-care and behavioral change. This research goes beyond previous care-management studies because it included patients at risk for a preference-sensitive condition decision in the future, and the health coaching included shared decision making and access to patient decision aids. The average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% lower than those in the usual-support group, largely due to a 10.1% reduction in annual hospital admissions.… Continue reading
Posted in Cost
Tagged decision aids, NEJM, preference-sensitive condition, shared decision making
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The DECISIONS Study: A Nationwide Survey of United States Adults Regarding 9 Common Medical Decisions
September 1, 2010
This article describes a survey of 3,010 adults age 40 and older to assess the frequency of which they made decisions regarding 1) initiation of prescription medications for hypertension, hypercholesterolemia, or depression 2) screening tests for colorectal, breast, or prostate cancer and 3) surgeries for knee or hip replacement, cataracts, or lower back pain. The study found that 82.2% of participants reported making at least one medical decision in the preceding 2 years, with 83% making a decision about screening, 61% about medications and 44% about surgery. The high frequency of medical decision making lends further weight to the importance of conducting shared decision making during routine care for these and other conditions.… Continue reading
Posted in Decision Quality
Tagged Carrie Levin, DECISIONS Study, Floyd J. Fowler, medical decisions, shared decision making
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Implementing Shared Decision Making in the NHS
July 25, 2010
Policies to promote shared decision making are becoming prominent in the United States, Canada, and United Kingdom. This is partly because of a recognition of the ethical imperative to properly involve patients in decisions about their care and partly because of the acrruing evidence that the approach has benefits. Shared decision making is an approach where clinicians and patients make decisions together using the best available evidence.… Continue reading
Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice
May 1, 2010
This largely theoretical article describes the balance between two medical decision making principles – beneficence and autonomy – and the growing shift towards a model of an autonomous, informed and participatory patient. The article proposes that shared decision making (SDM) strikes a balance between beneficence and autonomy and thus it should be adopted more widely. The authors review policy options for implanting SDM more widely through practice models, state policy incentives, and federal requirements. The article provides some detailed examples from health systems and states that have implemented SDM through the above models, and proposes a three-step process for implementing a nationwide practice of SDM.… Continue reading
Posted in Health Care Policy
Tagged Benjamin Moulton, ethics, informed patient choice, policy, shared decision making
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Implementing Shared Decision Making in the UK: A Report for the Health Foundation
April 1, 2009
Shared decision making (SDM) is a process in which patients are encouraged to participate in selecting appropriate treatments or management options. Not being properly told about their illness and the options for treatment is the most common cause of patient dissatisfaction. Most patients nowadays want more information and a greater say in decisions about how they will be treated. In SDM, patients are involved as active partners with the clinician in clarifying acceptable medical options and choosing a preferred course of clinical care.… Continue reading
Assessing the Quality of Decision Support Technologies Using the International Patient Decision Aid Standards instrument (IPDASi)
March 4, 2009
There has been increasing interest in the use of "decision aids", defined as adjuncts to the discussions clinicians have with patients during deliberations about decisions: these aids provide information about options and help clarify personal values. These adjuncts range from leaflets through face to face methods such as coaching or counselling to interactive multimedia websites. To describe this generic family of clinician-patient interventions we will use the term decision support technologies (DSTs), corresponding with the internationally recognised need to assess the impact of "health technologies." … Continue reading
Informing and Involving Patients in Medical Decisions: The Primary Care Physicians' Perspective
February 5, 2009
The Informed Medical Decisions Foundation commissioned Lake Research Partners (LRP) to conduct research with primary care physicians about SDM and patient decision aids. These are the results: Increasingly, patients are faced with medical decisions that have many options, uncertain outcomes, and benefits and harms that are valued differently by each individual. Shared decision making (SDM) recognizes the importance of having patients and providers work together to select tests and treatments. Patients and providers bring different expertise to the decision. Providers are mainly responsible for assimilating and appropriately applying evidence-based information and patients are responsible for sharing their preferences. Using SDM, well informed patients and providers can determine which choice matches what is most important to patients -- delivering high quality care that is both evidence-based and patient-centered.… Continue reading
Evidence-based Maternity Care: What it is and What it Can Achieve
October 1, 2008
Effective maternity care with least harm is optimal for childbearing women and newborns. High-quality systematic reviews of the best available research provide the most trustworthy knowledge about beneficial and harmful effects of maternity practices, yet these valuable resources are grossly underutilized in policy, practice, education, and research in the United States. Practices that are disproved or appropriate for mothers and babies in limited circumstances are in wide use, and beneficial practices are underused.… Continue reading
Bending the Curve: Technical Documentation
June 12, 2008
This document includes a cost analysis of implementing SDM for eleven procedures and estimates the savings to national health spending to be $3.8 billion over 5 years and $9.2 billion over ten years.… Continue reading
Posted in Cost
Tagged decision aids, health care costs, national health care, shared decision making, The Lewin Group
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Where are the Patients in Decision-making about Their Own Care?
May 11, 2008
Occasionally, all citizens have to make important health decisions that affect health outcomes. Strategies to support patient education and engagement should therefore be a fundamental plank of health policy. Also, patients can play an important role in understanding the causes of illness, protecting their health and taking appropriate action, choosing appropriate treatments for acute episodes of ill health, and managing chronic illness. These roles must be recognized and supported.… Continue reading
When Should You Involve Patients in Treatment Decisions?
October 1, 2007
There is much evidence that engaging patients in treatment decisions and supporting their efforts at self-care can lead to beneficial outcomes. Patients who are active participants in a shared decision-making process have a better knowledge of treatment options and more realistic perceptions of likely treatment effects. The resulting treatment choices are more likely to concur with their preferences and attitudes to risk. Actively engaged patients are also more likely to adhere to treatment recommendations, and less likely to select expensive procedures. However, patients' desires to play and active role in decision making varies, and, according to Cox et al., GPs are not very good at predicting what role patients want to play. What should be done about this problem?… Continue reading
Are Patient Decision Aids the Best Way to Improve Clinical Decision Making? Report of the IPDAS Symposium
September 20, 2007
This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making." … Continue reading
Effectiveness of Strategies for Informing, Educating, and Involving Patients
April 28, 2007
Policymakers increasingly believe that encouraging patients to play a more active role in their health care could improve quality, efficiency, and health outcomes. But critics have dismissed talk about patient engagement and patient centred care as political correctness -- a misplaced concern with the "touchy feely" aspects of health care, with no scientific basis and little relevance to the quest for excellence in clinical care. Who is right? To what extent is the planned shift towards greater patient engagement supported by robust research evidence?… Continue reading
Assessing the Quality of Information to Support People in Making Decisions about Their Health and Healthcare
November 1, 2006
Good quality health information is essential for greater patient involvement in healthcare. Patients and the public require information that is timely, relevant, reliable and easy to understand. This is an essential component of any strategy to promote health literacy, self-care, choice- shared decision-making, medication adherence and self-management of chronic disease. Patients have many decisions to make about their healthcare and, like all decision-makers, they require information to inform their choices. Reliable information is also essential to help patients understand their health problems and how to deal with them.… Continue reading
Patient-focused Interventions: A Review of the Evidence
August 1, 2006
Patient-focused interventions are those that recognise the role of patients as active participants in the process of securing appropriate, effective, safe and responsive healthcare. There is a growing belief among policy-makers that patients/citizens can contribute to quality improvement at both an individual and a collective level.… Continue reading
Developing a Quality Criteria Framework for Patient Decision Aids: Online International Delphi Consensus Process
July 13, 2006
Objective To develop a set of quality criteria for patient decision support technologies (decision aids). Design and setting Two stage web based Delphi process using online rating process to enable international collaboration.… Continue reading
Posted in Decision Aid Components, Patient Decision Aids
Tagged Angela Coulter, BMJ, Dawn Stacey, decision aids, decision support, Delphi, Glyn Elwyn
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Education for Partnership: Developments in Medical Education
May 11, 2006
What patients and the public expect from doctors is changing. It has always been expected that medical education will teach clinical knowledge and practical skills, as well as school students and trainees in a professional culture that emphasises their responsibility to be trustworthy and act in the interest of their patients. In recent years however, many people have come to expect more. Nowadays patients expect clinicians to respect autonomy, to listen to them, to inform them, to take account of their preferences, to involve them in treatment decisions and to support their efforts in self-care. … Continue reading
Engaging Patients in Their Healthcare: How is the UK Doing Relative to Other Countries
April 11, 2006
Most patients want to play an active role in their own healthcare. They want to know how to protect and improve their health when they are well; when they are ill they want information about the treatment options and likely outcomes; and, in addition to seeking fast effective health advice and care when they need it, most people also want to know what they can do to help themselves.… Continue reading
What Patients Want and the Public Want from Primary Care
November 17, 2005
The UK government has stated it wants the public to help shape the future of the health service. In the run-up to the planned publication of a white paper on care outside hospitals, Patricia Hewitt, secretary of state for health in England, is leading a big public engagement exercise to "genuinely involve patients, public and staff in designing family health and social care to meet the challenges of the 21st century. The secretary of state's commitment to engaging directly with the public is commendable if it is a genuine attempt to listen and learn, but she should also take account of the extensive body of research evidence on what patients and the public want. Patients have diverse needs and expectations leading to different, and sometimes conflicting, views on priorities, but it is possible to discern themes. What does the evidence show?… Continue reading
European Patients' Views on the Responsiveness of Health Systems and Healthcare Providers
August 11, 2005
Health systems throughout the world are searching for ways of making their services more responsive to patients and the public. The WHO has been encouraging this by including indicators of responsiveness in its World Health Reports. Many European governments have recognized that the future of socialized health care services depends on their ability to keep abreast of changing needs and respond to these in an appropriate way in order to sustain public confidence. Regular surveys of the views and experiences of patients and the public are beginning to be seen as an indispensable addition to the panoply of performance indicators used for monitoring the effectiveness of health policy. We report here a survey of random population samples in eight European countries focusing on public views of the quality of doctor-patient communications and opportunities for involvement in choice of providers and treatments.… Continue reading
Full Engagement in Health
November 18, 2004
In his review of future funding needs for the British NHS, Derek Wanless called for a new focus on moderating demand by investing in effective health promotion and disease management with the active involvement of individual patients and local communities. The fully engaged scenario, which entailed a radical change in professional and public roles, was the most ambitious of the three alternatives modelled by his team, but they concluded that it offered the best and most cost effective means of matching demand to supply of health care in the longer term.… Continue reading
Posted in Cost, Health Care Policy, Patient Involvement, SDM Implementation
Tagged Angela Coulter, BMJ, health care, health policy, NHS, patients, primary care, shared decision making, UK
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Perspectives on Health Technology Assessment: Response from the Patient's Perspective
November 11, 2004
Health technology assessment (HTA) involves values and judgements, but there have been few attempts to seek the views of members of the public or to ensure that they have access to the results. Patients and citizens can make an important contribution to HTA by determining priorities for assessment, designing and conducting assessments and appraisals, receiving and using the findings, and engaging in debates about policy priorities and rationing. Those responsible for HTA should make greater efforts to involve the public and ensure that the findings are accessible to patients for use when making treatment choices.… Continue reading
Policy Support for Patient-Centered Care: The Need for Measurable Improvements in Decision Quality
October 26, 2004
This article proposes that a new measure of decision quality be implemented in health care settings in order to ensure that patients receive the care they want and understand their health care decisions through measuring concordance of care given to patient preferences. The authors state that the quality of a clinical decision is the “extent to which it reflects the considered needs, values, and expressed preferences of a well-informed patient and is thus implemented.” They suggest that a valid assessment of decision quality would require: 1) decision-specific knowledge 2) values for the salient outcomes and 3) treatments chosen. The paper provides examples where similar measures have been incorporated into care processes.… Continue reading
Posted in Decision Quality
Tagged Floyd J. Fowler, Health Affairs, Karen Sepucha, patient-centered care, policy
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Patient Information and Shared Decision-Making in Cancer Care
August 14, 2003
It is increasingly recognised that clinicians are not the only target audience for clinical guidelines. Patients also have a legitimate interest in learning about best practice, including evidence-based standards and treatment options. The developers of the SOR clinical practice guideline programme deserve commendation for their efforts to meet these information needs. In producing well-designed patients' versions of the guidelines, they have set a high standard that other producers of clinical guidelines would do well to emulate.… Continue reading
Effects of Decision Aids for Menorrhagia on Treatment Choices, Health Outcomes, and Costs: A Randomized Controlled Trial
December 4, 2002
The call for increased patient participation in treatment decision making has come from a range of different perspectives. Methods to achieve these aims have included the development of patient decision aids. These can provide evidence-based information on treatment options and outcomes, help patients consider the personal value they place on benefits vs harms, and participate in decision about their care. Decision aids come in a variety of formats including leaflets, audiotapes, decision boards, computer programs, videos, Web sites, and structured interviews.… Continue reading
What do Patients Want from High-quality General Practice and How do We Involve Them in Improvement?
October 14, 2002
Patient involvement is being encouraged by the government and by others as a way of improving the quality of the service provided in general practice. Patients can be involved in their own individual care; for example, in treatment decision making and in disease management; or collectively, by providing feedback on aspects of practice organisation and quality.… Continue reading
Patients' Views of the Good Doctor
September 28, 2002
Most doctors are good doctors in the eyes of most patients. Despite the media's fixation with medical errors and damaged patients, doctors come high in popularity stakes in almost any poll, compared with other professions or trades. Furthermore, familiarity tends to breed contentment, not contempt. Patients who have recent experience of medical care tend to give higher, less critical ratings than patients who experience is less current. The medical profession does, however, attract criticism from patients -- sometimes deservedly so.… Continue reading
Posted in Patient Involvement
Tagged Angela Coulter, BMJ, doctors, health care providers, medical decisions, patients
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After Bristol: Putting Patients at the Centre
March 16, 2002
Improving responsiveness to patients has been a goal of health policy in the United Kingdom for several decades. Until now, most initiatives in this area have failed to change noticeably the everyday experience of most patients in the NHS. The harsh realities of budgetary pressures, staff shortages, and other managerial imperatives tend to displace good intentions about informing and involving patients, responding quickly and effectively to patients' needs and wishes, and ensuring that patients are treated in a dignified and supportive manner. This is the essence of patient centred care, and most health professionals strive to achieve it.… Continue reading
Randomised Controlled Trial of an Interactive Multimedia Decision Aid on Benign Prostatic Hypertorphy in Primary Care
April 6, 2001
The rationale for decision aids is addressed in the accompanying paper. Unlike hormone replacement therapy, prostate surgery is a "Rubicon" procedure -- that is, once undertaken it cannot be reversed. In the United States, a pilot study on the impact of a programme to aid in decisions about benign prostatic hyperplasia showed a 40% decrease in surgery rates. This finding was not replicated in a subsequent randomised controlled trial.… Continue reading
Randomized Controlled Trial of an Interactive Multimedia Decision Aid on Hormone Replacement Therapy in Primary Care
April 6, 2001
Decision aids to assist patients in deciding about health care have been welcomed as one solution for improving doctor-patient communication, providing information for patients, and addressing the shortcomings in much of the information available. Both patient outcomes and the rational use of health service resources may be improved by better provision of information.… Continue reading
Patient Choice Modules for Summaries of Clinical Effectiveness: A Proposal
March 17, 2001
Evidence based health care has become the accepted basis of good clinical practice, and many efforts are being made to implement it. Evidence based patient choice, defined as offerring patients research based information and the opportunity to influence decisions about their treatment and care, has yet to achieve the same status. We believe, however, that is is fundamental to high quality patient care.… Continue reading
Determining the Need for Hip and Knee Arthroplasty: The Role of Clinical Severity and Patients' Preferences
March 1, 2001
In this study, patients with hip or knee arthritis were assessed for their need and willingness to undergo arthroplasty in two geographic regions with high and low use of the procedure. Patients were assessed for this clinical appropriateness for surgery, and then participated in an interview where they were told the consequences of not having surgery, alternative treatments, risks and benefits of surgery, and potential risks of surgery. Among individuals that were deemed clinically appropriate for surgery, only 14.9% in the high-rate area and 8.5% in the low-rate area responded as being definitely willing to undergo arthroplasty. The great variation between those patients who are clinically appropriate versus willing to undergo surgery suggest that patient values should be more routinely incorporated into clinical decisions.… Continue reading
Sharing Decisions with Patients: Is the Information Good Enough?
January 30, 1999
Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest as a means by which patients' preferences can be incorporated into clinical decisions. When there are several treatment options which may have different effects on the patient's quality of life, there is a strong case for offering patients choice. Their active involvement in decision making may increase the effectiveness of the treatment.… Continue reading
Evidence Based Patient Information Is Important, So there Needs to be a National Strategy to Ensure it
July 25, 1998
Leaflets and other information packages (video and audio tapes, computer programs, and websites) have long been seen as integral to educational strategies designed to promote health, persuade people to adopt healthy lifestyles, and increase uptake of screening. They have also been developed to educate patients in self care of such chronic conditions as arthritis, hypertension, stress related psychological problems, gastrointestinal diseases, and back pain, and how to take medicines correctly. There is now growing interest in providing information to support patients' participation in choosing treatments and deciding on strategies for managing their health problems. … Continue reading
Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making
April 15, 1997
The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.… Continue reading
Using Interactive Videos in General Practice to Inform Patients about Treatment Choices: A Pilot Study
December 15, 1995
Our objective was to assess the acceptability of using an interactive video system in a general practice setting to inform patients about treatment choices. A descriptive cohort study was carried out in eight general practices in Oxfordshire. Fifty-four patients with mild hypertension and 29 with benign prostatic hypertrophy were studied. Patients' views of the video, treatment preference, level of involvement in treatment decision and satisfaction with decision-making process and GP's views of the effect of the video on subsequent consultations were measured.… Continue reading
Posted in Decision Aid Components, Decision Aid Effectiveness, Patient Decision Aids, Patient Involvement, SDM Implementation
Tagged Angela Coulter, benign prostatic hypertrophy, decision-making, general practice, informed decisions, informed patients, interactive videos, patients, treatment decisions, UK
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