Published on March 12, 2014
Victor M. Montori, MD, MSc Mayo Clinic Shared Decision Making Toward Evidence-based Patient-centered care email@example.com @vmontori
Weymiller et al. Arch Intern Med 2007 Statin Choice Web
Compared to usual care, patients using the decision aid were 22 times more likely to have an accurate sense of their baseline risk and risk reduction with statins. Weymiller et al. Arch Intern Med 2007
Osteoporosis Choice Montori et al, AJM 2011
Chest Pain Choice Hess et al. Circ 2012
Mullan et al, Arch Intern Med 2009 Diabetes Medication Choice Video / Web
Depression Medication Choice LeBlanc 2012
Examples Decision aid Evaluation Risk communication tools Statin Choice (primary care) Feasible, effective Independently validated Multicenter trial completed Implemented in EHR Chest pain Choice (emergency) Feasible, effective (Emergency) Multicenter trial seeking funding Aspirin Choice (primary care) Implemented in EHR without evaluation Osteoporosis Choice (primary care) Feasible, effective EHR implementation ongoing PCI Choice (cardiology) Ongoing AMI Choice (hospital) Feasible, effective (hospital) Issue cards DM2 Med Choice Feasible, effective Multicenter trial ongoing Implemented in EHR Depression Choice Ongoing
The body of evidence Systematic review of 115 RCTs Compared to usual care, decision aids: Increase patient involvement by 34% (+++-) Increase patient knowledge of options by 13% (++++) Increase consultation time by ~2.6 minutes Reduce decisional conflict by ~7% Reduce % undecided by 40% No consistent effect on choice, adherence, health outcomes or costs Stacey D et al. Cochrane review 2014
Summary of Mayo experience Age: 40-92 (avg 65) Primary care, ED, hospital, specialty care 74-90% clinicians want to use tools again Adds ~3 minutes to consultation 60% fidelity without training 20% improvement in patient knowledge 17% improvement in patient involvement Variable clinical outcomes
Conclusions • It is feasible to promote evidence-based conversations during the clinical encounters with patients with chronic conditions. • Decision aids designed for this purpose are efficient and effective in promoting shared decision making. • Tools tested in randomized trials and proven effective are available for free. • Partners to get to routine use in practice.
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