Featured Shared Decision Making PublicationsView all results of this resource type.
This article describes a study that found that patients with cancer who viewed a video of various goals-of-care options, in addition to a verbal description were more likely to prefer comfort measures and avoid CPR. The study found that these patients were also more knowledgeable regarding advanced care treatment options and felt more certain about their decision compared to patients only hearing a verbal narrative. This article differs from some other studies regarding decision aids since other uses of video decision support tools have focused on helping people make treatment or screening decisions, whereas this video was used to initiate end-of-life discussions.
This is the most comprehensive review article that examines evidence of patient decision aids from numerous randomized control trials and provides a strong evidence base for the positive benefits of patient decision aids. The review finds that when patients use decision aids they: a) improve their knowledge of the options b) have more accurate expectations of possible benefits and harms c) reach choices that are more consistent with their informed values and d) participate more in decision making.
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.
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.
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.
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.
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.
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.
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."
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."
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?
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.
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.
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.
Posted in Patient Decision Aids, Patient Involvement, Special Populations
Tagged Angela Coulter, decision aids, doctor-patient communication, health care, hormone replacement therapy, multimedia, patients, primary care, Shared Decision-Making® programs, women
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.
Posted in Patient Decision Aids, Patient Involvement, Special Populations
Tagged Angela Coulter, benign prostatic hyperplasia, BMJ, BPH, decision aids, decision-making, men, multimedia, primary care, prostatectomy, Shared Decision-Making® programs, treatment decisions
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.
Posted in Patient Decision Aids, Patient Involvement, SDM Implementation
Tagged Angela Coulter, BMJ, decision aids, decision-making, doctor-patient communication, empowering patients, evidence-based medicine, health care, patient choice, treatment decisions
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.
Posted in Decision Aid Components, Patient Decision Aids, Patient Involvement, Patient Preferences
Tagged Angela Coulter, BMJ, decision aids, decision-making, patient-centered care, preference-sensitive care, shared decision making, treatment decisions
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.
With any surgery, consent must be obtained from each patient, and valid consent is based on knowledge of the options, the risks and benefits of each option, and the likelihood that these will occur for the individual patients. The legal doctrine and requirements of informed consent are well known. In theory, informed consent is a process, not a moment in time. In reality, it has occurred when a clinician requests a signature from a patient to authorize that a specific treatment or procedure take place, and the patient signs. In current practice, there is no requirement that shared decision-making occur before the signing of the consent form.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM Implementation
Tagged consent form, Dartmouth-Hitchcock Medical Center, decision aids, decision-making, informed consent, informed decisions, informed patient choice, Medicare, patient-centered care, patients, shared decision making, surgery
Support for a model of shared medical decision making, where women and their care providers discuss risks and benefits of their different options, reveal their preferences, and jointly make a decision, is a growing expectation in obstetric care. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of different decision aid tools compared to regular care for women facing several option in the specific field of obstetric care. We included published studies about interventions designed to aid mothers' decision making and provide information about obstetrical treatment or screening options.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM in Maternity Care, Special Populations
Tagged childbirth, decision aids, decision support, decision-making, doctor-patient communication, health education, informed consent, obstetrics, patient-centered care, pregnant women, shared decision making, women
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
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
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.