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.
This article describes a survey of 3,010 adults age 40 and older to assess the frequency of which they made decisions regarding 1) initiation of prescription medications for hypertension, hypercholesterolemia, or depression 2) screening tests for colorectal, breast, or prostate cancer and 3) surgeries for knee or hip replacement, cataracts, or lower back pain. The study found that 82.2% of participants reported making at least one medical decision in the preceding 2 years, with 83% making a decision about screening, 61% about medications and 44% about surgery. The high frequency of medical decision making lends further weight to the importance of conducting shared decision making during routine care for these and other conditions.
Most doctors are good doctors in the eyes of most patients. Despite the media's fixation with medical errors and damaged patients, doctors come high in popularity stakes in almost any poll, compared with other professions or trades. Furthermore, familiarity tends to breed contentment, not contempt. Patients who have recent experience of medical care tend to give higher, less critical ratings than patients who experience is less current. The medical profession does, however, attract criticism from patients -- sometimes deservedly so.
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