Dr. Michael Barry, a primary care physician at Massachusetts General Hospital and president of the Boston-based Informed Medical Decisions Foundation, said he broaches PSA screening with his patients in their 50s and 60s, discussing the risks and benefits, and will continue to do so. “Although the benefit is small, the magnitude is in the eye of the beholder,” he said.
Support Aligned Incentives for Patient Engagement
Together we can create a more patient-centered health care system.
Support Aligned Incentives for Patient Engagement
In May 2013, the Informed Medical Decisions Foundation and the Gordon and Betty Moore Foundation convened a meeting of key stakeholders to consider the ways in which promoting shared decision making could facilitate greater patient and family engagement in health care. The group affirmed the process of shared decision making as the pinnacle of patient and family engagement in health care, believing that optimal health care decisions can be made only when patients are fully informed of their options and work with a care provider who is aware of their goals and concerns.
The group endorsed a broad definition of patient and family engagement as the active participation of patients and their family members in a health care system that they are partners in designing and that is shaped by, respectful of, and responsive to their needs, as they define them. The group also endorsed a definition of shared decision making as a process in which care providers and patients work together to select tests, treatments, and care plans, based on clinical evidence and the patient’s informed preferences.
Recognizing that in our current system patients and families are rarely invited to be fully active participants in their health care, we call upon all stakeholders to take the following actions to promote patient and family engagement and shared decision making:
- Replace the outdated view of patients as passive recipients of health care with one in which patients and their families are active participants and meaningfully engaged at every level, including system design and policy making.
- Support and accelerate the culture change in health care that is required to enable effective patient and family engagement in shared decision making.
We call on health systems, providers, and professional societies to:
- Build and promote an organizational culture in which patient and family engagement is valued and expected.
- Create processes that encourage greater communication and collaboration while ensuring true patient and family involvement in their care before, during, and after every encounter.
- Create an environment where providers routinely invite patients to share in all health decisions where there is more than one reasonable choice and enable them to express their preferences and concerns.
- Assure that patients and their families have access to reliable, unbiased, evidence-based information about their treatment options.
- Provide or participate in education and skills training in shared decision making and patient and family engagement for clinical teams.
We call on policy makers, payors, and employers to:
- Incentivize shared decision making within fee-for-service reimbursement rules, bundled payment programs, medical homes, and accountable care organizations.
- Develop novel health plan benefit design programs that incentivize shared decision making.
- Create and adopt policies in partnership with patients and families that encourage shared decision making, including its measurement, as a stimulus for quality and safety improvement.
- Continue to pass legislation to promote shared decision making as a better form of informed consent for preference-sensitive conditions.
Set standards for patient decision aids building on the work of the International Patient Decision Aids Standards collaboration (IPDAS).
Strengthen the link between criteria for Meaningful Use of health information technology with the timely provision of patient decision support materials.
We call on patients and their families to:
- Ask providers about your options when making a health decision, including benefits, harms and uncertainties, and the likelihood of each outcome.
- Be open in telling your provider about your health goals, concerns, and preferences.
- Partner with providers and health systems in designing, implementing and evaluating shared decision making programs.
We call on journalists and communicators to:
- Highlight the ethical, safety, and cost implications of care delivery when patients and families are not engaged, informed and involved.
- Share success stories from organizations that have implemented shared decision making and meaningful patient and family engagement.
- Communicate key messages about shared decision making, including its time-effectiveness, high acceptance by patients, and its potential to reduce unwanted care.
By joining forces, we can create a system of compassionate, respectful care that invites active participation of patients and their families and reaps the benefits of that engagement—higher levels of quality, safety, and efficiency, as well as improved health outcomes. We believe that only with full engagement of patients and families can we achieve the goal of a transformed health care system. We hope all stakeholders will join us in this most important endeavor.