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.
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
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.
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.
Posted in Cost, Decision Aid Effectiveness, Patient Decision Aids, SDM Implementation
Tagged arthritis, David Arterburn, decision aids, Group Health, Health Affairs, health care cost, hip osteoarthritis, informed decision, knee osteoarthritis, surgery
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.
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.
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.
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.
May 9, 2012
Women with early-stage breast cancer face a multitude of decisions. The quality of a decision can be measured by the extent to which the treatment reflects what is most important to an informed patient. Reliable and valid measures of patients' knowledge and their goals and concerns related to breast cancer treatments are needed to assess the decision quality.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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