Shared Decision Making - intermediate

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Information about Shared Decision Making - intermediate
Health & Medicine

Published on March 12, 2014

Author: kerunit


Victor M. Montori, MD, MSc Mayo Clinic Shared Decision Making Toward Evidence-based Patient-centered care @vmontori

Encounter Research

Glasziou and Haynes ACP JC 2005

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

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

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

AMI Choice

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

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

    • Clinician decides how & when to use - and may elect not to use • “Considerations” and “What You Should Know” cards are not given to patient as part of the comparison process Clinician and patient discuss the “What You Should Know” card. Patient selects a second card and compares the two. Clinician asks, “What issues concerning a medication to treat depression symptoms would you like to discuss firs t ?” Patient selects firs t card. Medication options are discussed. Patient and clinician review this card. Medication choice is made– brochure given to patient to take home. a clinician guide to: Using the Depression Medication Choice Decision Aid (DA) with Patients

Statin Decision Aid

Web-based tool

Empathic decision making Partnership Dance across models Support deliberation

Incorporate research evidence and clinician’s expertise into patient decisions

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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