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Decision Quality
Decision quality describes the agreement between what an informed patient really wants and the treatment he or she actually receives. Measuring decision quality helps shed light on ways to improve the decision making process and whether or not "good" treatment decisions are being applied in the practice of medicine.
Measuring decision quality can be a challenge. Researchers must assess:
- whether a patient has the knowledge to make an informed decision.
- whether or not the final decision reflects the patient's preferences.
- whether or not the patient is satisfied with the treatment decision made.
Our Library
Below you will find samples of our most recent acquisitions in Decision Quality, 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
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
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
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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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
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
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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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
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
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
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
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
