A review of the 86 trials included in the 2011 Cochrane Review of decision aids found great variability in the reporting of decision aid effectiveness. In some studies, the measures used to evaluate decision quality and other outcomes were not named. In other studies, the decision aid tool itself was not well described, making it hard to know what components were part of the DA.
Read more about the IPDAS Reporting Guidelines Workgroup
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.
Read more about who benefits the most from shared decision making
Medicaid plays a key role in maternal health in the United States, financing 40 percent of all births each year. And since many states have extended Medicaid coverage to pregnant women up to or over 185 percent of the poverty level, this percentage will only increase. Like all moms, moms on Medicaid want to do everything they can to ensure their own health and the health of their babies. There are many decisions that women need to make during pregnancy, ranging from decisions about prenatal testing to labor and delivery interventions like induction and Cesarean. For many of these decisions, there is no right or wrong answer.
Read more about how to engage Medicaid moms in health care decisions
With shared decision making on the lips of many in health care conversations these days, I’d like to address five common myths about using shared decision making to make care more patient-centered.
Read more about the myths of shared decision making
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.
Read more about how to improve the evaluation and impact of decision aids
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.
Read more about how to demonstrate the value of decision aids
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
Recent clinical practice guidelines from the United States Preventive Services Task Force (USPSTF) recommend against PSA screening for men of all ages, while other guideline groups, including the American Urological Association (AUA) and the American College of Physicians (ACP), recommend a shared decision making (SDM) approach to the prostate-specific antigen (PSA) test. “Dueling guidelines” can create confusion for people who are facing a health decision, as well as for their clinicians.
Read more about the results of a study on decision aids for PSA testing
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