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.

Current News from the Informed Medical Decisions Foundation

Shared Decision Making and Evidence-Based Practice Unite in Sydney

ISDM2015Every other year, members of the shared-decision-making community gather in a different hub of the world to discuss the evolution of patients and providers engaging in a collaborative conversation around health care decisions. This July, the gathering was quite the landmark event as shared decision making and evidence-based practice united at the first joint International Shared Decision-Making/International Society for Evidence-Based Health Care (ISDM/ISEHC) Conference in Sydney, Australia. Over 300 people from around the globe met at the University of Sydney July 19–22 to share knowledge and inspire action to improve the entire care experience.

Three of our very own attended and also presented during the event: Ben Moulton, senior vice president of the Foundation; Richard Wexler, chief clinical integration officer; and Carrie Levin, research director. We spoke with them about highlights of the meeting.

  • From an advocacy and policy perspective, many in attendance are looking at the policy implications of SDM. One particular area of focus is around informed consent, which is gaining importance as a lever for broad use of SDM. Too often the informed-consent process is based on a signed form rather than a collaborative conversation around the best available evidence and the patient’s informed preferences. The evolution of informed consent is beginning, and the new standard should document that shared decision making has occurred.
  • Attendees agree that SDM is the right thing to do, but the question of how to incentivize SDM was a discussion among a special interest group. In the end, the feeling was that aligned incentives are necessary to maximize SDM. And it’s important to note that incentives don’t always need to be monetary. Looking ahead, we need to study the various circumstances and incentivize accordingly.
  • Family engagement in the decision-making process is gaining more traction and leading the way for a triad (patient/family/care team) instead of a dyad (patient/care team). Many discussions in Sydney focused on how to involve family members in decisions about their loved one’s health care. We’ve talked long enough about why we need family engagement, and now we need to move beyond it being a great idea and make it a reality.
  • Training of medical students was the subject of a number of presentations throughout the 4-day event. The competition for spots in medical school curriculum is quite high, and unfortunately communication skills generally don’t make the cut. Training of SDM skills has struggled to find a spot in the past, but it may be more effectively paired with evidence-based practice than communication. Asynchronous learning is one approach, and we’ve developed an online course for providers that helps them strengthen their communication skills so conversations are built around evidence-based practice and patient preferences. Researchers at Dartmouth are also exploring this type of learning program.

Check out #ISDMISEHC for reflections from other attendees about this landmark event.

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Michael J. Barry, MD

Doctors Keeping Up: A Patient and Doctor Perspective

By: Michael J. Barry, MD and Patty Skolnik Editor’s note: The following exchange is a conversation between Patty Skolnik and Michael Barry regarding the current controversy about physicians’ maintenance of their licensure and certification. Patty Skolnik is the founder and … Continue reading

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Michael J. Barry, MD

The President’s Corner: July/August 2015

In a 2012 report for The King’s Fund, Foundation cofounder Al Mulley and colleagues described the problem of misdiagnosis of patients’ preferences. “Preference misdiagnosis” may be the most common form of medical error in health care. It can occur when a person has more than one medically reasonable course of action open to him or her. A clinician, sometimes supported by recommendations from clinical practice guidelines, may prescribe or withhold a treatment based on what the evidence best supports and what he or she thinks the patient would want. However, research shows that among fully informed patients who understand a certain treatment’s possible benefits and risks, some would want that prescribed treatment, and some would not want that treatment prescribed. While there is evidence that preference misdiagnosis occurs, its epidemiology and solutions have not been well described. Continue reading

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Jack Fowler

Three Elements for Better Studies Evaluating the Effects of Decision Aids

The study designs needed to collect this data vary, and no one study is going to collect data addressing all of these important evaluative questions. However, we very much need more quality data on when and how using DAs affects patient care, and we should try to take advantage of every opportunity to collect good evaluation data when DAs are introduced into a new setting. There are three elements to think about when considering the collection of evaluation data. Continue reading

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Jack Fowler

Do the Decision Aids Lead to Better Decisions?

How would we know a “better” decision if we saw one? Donald Berwick, former director of the Centers for Medicare and Medicaid Services, proposed what he called the “Triple Aim”: better health care and better health at lower cost. One way to answer the question of whether the decisions are “better”—and thereby demonstrate the “value” of using DAs and other patient support materials—is to collect data to evaluate how each of these aims is affected. Continue reading

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