DHMC - Dartmouth-Hitchcock Medical Center, General Internal Medicine

WRJVA - White River Junction VA Medical Center

PGH - Pittsburgh VA Health Care System

At Dartmouth-Hitchcock Medical Center, patient decision aids are distributed either via a “pre-visit” model or a “post-visit” model, depending on the clinical topic. Patients with certain conditions, such as those involving a specific biopsy-based diagnosis like breast cancer or prostate cancer, can be readily identified prior to their initial visit.

In these situations, staff sends the patient a video-based decision aid for viewing at home prior to the first evaluation with a physician (the pre-visit model). Decision support counseling is also available to any patient before or after their visits with physicians. Staff identifies patients eligible for screening test-related decision aids through demographic information such as age and gender and distributes decision aids prior to preventive care visits. Physicians prescribe decision aids for viewing after a visit when the when patients are considering their treatment options for such conditions as osteoarthritis of the knee or diabetes.

In addition to the decision aid, patients receive (or access online) questionnaires which they complete and return prior to their next clinical encounter. Health care providers use the information from the questionnaires to get a better understanding of the patient's preferences and values, as well as his or her basic grasp of the condition or screening test, prior to embarking on a shared decision-making process with the patient.

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