January 27, 2010, Washington, DC
Health care experts, front-line clinicians, and patients presented their unique perspectives on shared decision making—its value, its ethical basis, and its potential for bridging important gaps in the health care system—at this day-long gathering in Washington, DC. Clinicians and investigators described on-the-ground implementation projects, in which shared decision making and patient decision aids are changing the way patients and health care providers communicate and experience the delivery of care. Political analysts presented their views on the current status of federal and state legislation on health reform and the potential for such legislation to foster widespread implementation of shared decision making. And Foundation president, Dr. Michael Barry, unveiled the organization's new mission statement to overwhelming approval: “Amplifying the patient's voice in health care decisions.”
Summaries and video clips of all forum presentations can be found below.
Gerd Gigerenzer, Director, Max Planck Institute for Human Development
Dr. Gigerenzer posited that an accurate understanding of risk is a precondition for shared decision making. He outlined several strategies for addressing the “collective statistical illiteracy” that currently exists among politicians, health care providers, and patients.
Michael Barry, President, Foundation for Informed Medical Decision Making
Dr. Barry provided an overview of the current status of shared decision making in the United States. He suggested that the most significant challenges at present are the logistical ones associated with widespread distribution of decision aids and use of the shared decision making process.
Jeffrey Belkora, Director, Decision Services, UCSF Breast Care Center
Dr. Belkora explained the innovative decision support services available for patients with breast cancer at the UCSF Breast Care Center. Alexandra Teng, a current premedical trainee, described her experience with patient support and its impact on her thinking about patient care.
Larry Morrissey, Medical Director, Stillwater Medical Group
Dr. Morrissey described the actions taken at Stillwater Medical Group, a multi-specialty physician group in Minnesota, to promote shared decision making as a facet of patient-centered care.
Donald Kemper, Chairman & CEO, Healthwise
Mr. Kemper outlined three basic approaches to encouraging the use of decision aids: push systems, in which providers prescribe information specifically tailored to a patient's needs; pull systems, in which patients access decision aids licensed to certain websites; and pay systems; in which patients and providers receive financial rewards for engaging in shared decision making.
David Wennberg, Chief Science & Products Officer, Health Dialog
Dr. Wennberg described a proposed program in Maine that seeks to reduce unwarranted variation in care by aligning incentives for providers and health systems. The program is based on a payment model that rewards providers and patients for engaging in shared decision making and calls for public display of claims data to increase transparency.
Carmen Hooker Odom, President, Milbank Memorial Fund
With the passage of the Washington state legislation in 2007, legislators formally acknowledged shared decision making and the benefits of decision aids for the first time. Ms. Odom reviewed the current status of legislation regarding shared decision making in eight other states in which law makers are contemplating similar legislation.
David Arterburn, Assistant Investigator, Group Health Center for Health Studies
Dr. Arterburn described the journey of Group Health staff and leaders to implement shared decision making widely throughout the organization as part of a state-mandated demonstration project. He highlighted the essential lessons that members of the implementation team have learned over the past two years and presents preliminary outcomes data.
Mary Ann O'Sullivan, Executive Director, Campaign for Effective Patient Care Studies
The newly formed advocacy group, Campaign for Effective Patient Care, chose as its first initiative the promotion of shared decision making. Ms. O'Sullivan discussed the reasons for the decision, including voter concerns about “rationing” of health care. She also presented the organization's strategic plans for the coming year.
Peter Lee, Executive Director for National Health Policy, Pacific Business Group on Health
John E. Wennberg, Peggy Y. Thomson Professor (Chair) in the Evaluative Clinical Sciences & Founder and Director Emeritus, The Dartmouth Institute for Health Policy and Clinical Practice
Mr. Lee suggested areas for improvement in the current health reform bills, such as adding strong conflict of interest statements to facilitate shared decision making. Dr. Wennberg discussed how accountable care organizations, bundled payments, and the medical home concept might affect the implementation of shared decision making.
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