Advancing Shared Decision Making
The Informed Medical Decisions Foundation, now a division of Healthwise, has been working to advance evidence-based shared decision making since 1989. We believe the only way to ensure that high quality health care decisions are being made is for a fully informed patient to participate in a shared decision making process with their clinician. Through our research and advocacy efforts, we are dedicated to helping people make better health decisions.
Today’s guest blogger is David Arterburn, MD, MPH. He is an associate investigator at the Group Health Research Institute in Seattle and an internal medicine physician at Group Health. He has served as medical editor for the Informed Medical Decisions Foundation, now a division of Healthwise, for many years.
At Group Health, we are creating a culture of expectation that no preference-sensitive medical decision is made in the face of insufficient knowledge among patients about their options and that patients’ preferences are aligned with their treatment decisions.
In 2009, we began implementing patient decision aids and processes to support shared decision making (SDM). Initially we focused more on the delivery of decision aids, but we realized within the first year that the most important aspect of the work was engaging our providers in understanding best practices for decision making. Many providers think they are doing shared decision making. But when you explain what the Six Steps of SDM are, providers realize that they aren’t doing so well, especially around preference diagnosis and ensuring that the patients’ preferences are informing the decision. Our leadership recognized this gap, and we set out to train providers in best practices and competencies for shared decision making.
We decided to focus on specialty care first. So in 2010 we took 90% of our practicing surgeons and specialists out of the clinic and operating room to attend one of three half-day CME trainings on shared decision making. We invited experts from Dartmouth and the Informed Medical Decisions Foundation to facilitate this training for our specialty care providers. The training was very well received by providers and leadership, but an in-person training is not the most cost-effective and efficient way to train providers in new skills. In addition to time and cost required to host an in-person training, there’s also turnover in providers and staff to consider. So we knew that we needed this to be more of an ongoing focus for Group Health and not just in specialty care, because now more than half of all our patient decision aids are prescribed by primary care physicians.
So in 2014, we worked with Healthwise and the Informed Medical Decisions Foundation to pilot their online interactive Shared Decision Making (SDM) Skills Course in Olympia, at our largest primary care clinic, and in Seattle, at an orthopedic clinic. Of the 49 providers that we contacted at these two sites, 39 completed the SDM Skills Course. We just recently finished the pilot, and early results show that there is definitely a need for training—there was a baseline deficit in knowledge of key skills for shared decision making going into the pilot and the providers’ knowledge greatly improved immediately following completion of the course. Plus, using an online training program will allow us to refresh our providers’ training on SDM in an ongoing way without requiring as many resources as an in-person training.
Following the success of the SDM Skills Course pilot at these two Group Health clinical sites, we’re looking to train our entire medical staff over the next few years. We see shared decision making as a natural fit for Group Health providers, and we want it to be an expected component of clinical practice here. Having a large toolbox in terms of available decision aids that providers can prescribe is one key component of successful implementation of shared decision making. The other key component is having providers who are trained on the steps of SDM and who understand how to incorporate decision aids into clinical practice. You have to have both components to be successful, and that’s what we’re aiming for at Group Health.
Today’s guest blogger is Leslie Kelly Hall. She is senior vice president of policy at Healthwise. Leslie guides policy efforts for health information technology, standards, interoperability, privacy, and security that will help people engage in their health.
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