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.
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Last week we considered what a “better” decision means and how we can evaluate whether decision aids (DAs) are positively affecting decisions themselves. We’ve also looked at evaluating the effects of DA exposure on the decision-making process and whether DAs were disseminated to the right people. 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.
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Last week we looked at evaluating the effects of decision aid (DA) exposure on the decision-making process. Our final evaluative question asks whether the DAs are actually helping patients make better health 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. Triple aims, of course, entail three different kinds of evaluations.
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Last week we discussed the imperative of evaluating whether decision aids are being disseminated to the patients who need them. The next key evaluative question is this: How was decision making affected by exposure? There are a number of reasons to introduce accurate, complete, understandable information to patients. And a comprehensive assessment of how well those objectives are achieved requires appropriate data collection procedures and measurement.
Read more about how to assess the affects of decision aid exposure
Last week I mentioned that there is still much to learn about decision aids (DAs), specifically how to evaluate and document their effects on informing and supporting patients in health care decisions. Any evaluation of the effects of adopting DAs has to start with the question of the extent to which they are used by the patients who need them. How well are they disseminated? This, in turn, requires collecting four different kinds of information.
Read more about getting decision aids into the hands of patients that need them
Decision aids (DAs) are designed to help people facing medical decisions by providing up-to-date information about the reasonable options for their care, what is known about the pros and cons of those options, and perspectives on the reasons one might choose one or another of the alternatives. The Cochrane Collaboration is an international group of researchers who review evidence across numerous clinical trials on the same topic to determine what generalizations they support. In 2014, the Cochrane Collaboration included 115 randomized trials in its latest review of the effects of DAs. The conclusions were that DAs consistently improved patient knowledge and increased patient sense of readiness to make a decision. Yet, despite all these studies, there is still much that we do not know and that remains undocumented about these important patient support tools.
Read more about what we still need to learn about decision aids
In a paper published online in JAMA Internal Medicine on May 27, 2013, Tak and colleagues presented the results of a study describing the association between hospital costs and length of stay, and hospitalized patients’ answers to a question about whether, “I prefer to leave decisions about my medical care up to my doctor.” The roughly one-third of participants in the study who “somewhat” or “definitely” disagreed with this statement had significantly higher mean length of stay (by about a quarter of a day) and total hospital costs (by about $900).
Read more about why this conclusion about SDM is inappropriate