Not long ago, I was talking with a news reporter about an article we published on how surgical decisions are made. The paper reported that surgery patients too often were not given enough information about reasonable options. During our discussion the reporter remarked that the findings of the study were all well and good for some people, but didn’t apply to her elderly dad. Her dad would never have wanted to have information or be involved in medical decisions about his care. Instead, he would just look to his wife to tell him what to do.
Each "Voices" blog segment will feature a person we believe has a unique and valuable perspective on shared decision making. Today's guest is Peter Ubel, MD, author of "Critical Decisions." 1) In your own words, what is shared decision making and how does it improve the quality of health care? Put simply, shared decision making is the gold standard -- the sine qua non* -- for how medical decisions ought to be made. The pipe medical choice is rarely a function of medical facts alone. Tough decisions require value judgments, and it is the patient’s values that often determine which choice is best. An operation cannot be a “success” unless it was the right course of action to take for an individual patient. Treatment cannot “work” unless it was the treatment that best fits that patient’s individual preferences. Quality of care begins with shared decision making.
The National Survey of Medical Decisions was designed to collect nationally representative data from adults age 40 and above on a variety of medical decisions from the patient perspective, using a random digit dial (RDD) telephone survey.
In order to make informed medical decisions, patients need to understand information about risks, benefits and drawbacks of different treatments. However, research on health literacy and medical decision making has shown that patients in different cultures have severe problems grasping a host of numerical concepts that are prerequisites for understanding health-relevant statistical information. Graphical displays -- including line plots, bar charts or icon arrays -- often facilitate the communication of numerical information, and can help overcome some of these difficulties.
Posted in George Bennett Grants, Literacy and Numeracy, Risk Communication
Tagged data displays, graphic comprehension, graphical displays, health care, health literacy, informed decision making, low graph literacy, medical decisions, patients, shared decision making
Our early decision aids were created on Laser Videodiscs, seen above. These Laser Discs are about the size of a LP record and have to be played on special player that typically cost around $8,000. While the disc may look fairly primitive, in reality it was very advanced and innovated. Like computerized decision aids today, you were able to customize content based on each person, and input data to better assist in making decisions. The disc above is a Treating Your Breast Cancer decision aid, aimed at helping women choose the best course of treatment for them. Our very first decision aid was a Benign Prostate Hyperplasia aid (BPH), created in 1990 in VHS format. We have come a long way since laser discs and VHS, but continue to work hard at creating decision aids to help people make informed health care decisions.
The Foundation funded the well known DECISIONS study
, which was published in the 2010 September/October publication
of Medical Decision Making
. The DECISIONS study was designed to collect data on a variety of medical decisions from the patient's perspective, using a random digit dial (RDD) telephone survey. Both Carrie Levin
and Jack Fowler
from the Foundation were heavily involved in the research, along with the other authors from University of Michigan. The study found that most US adults face medical decisions with life-saving, quality of life and cost implications. Further it found that when making these medical decisions with their provider, the reasons to act (pros) were prominently discussed, while the reasons not to (cons) were not as much. In these discussions, the providers often gave their opinions and rarely asked for the patients opinion. In addition, the respondents rarely knew key facts relating to their health care decision. This study revealed what the Foundation long suspected, that patients are not involved or knowledgable in their health care decisions, showing the need for shared decision making.