Your SlideShare is downloading. ×
0
Health Literacy, Numeracy and   Shared Decisionmaking        Sue Stableford, MPH, MSB, Director University of New England ...
Preview • ACA and shared decisionmaking • Health literacy, numeracy, and risk   communication • Challenges and emerging so...
Affordable Care Act Sec 3506Program to Facilitate Shared Decision-Making“…facilitate collaborative processes between  pati...
Shared decisionmaking (SDM)• Key concept: “Preference-sensitive” care  – Possible harms and benefits    closely matched  –...
Shared decisionmaking            enhances care quality• Linked with  – patient-centered care  – safety and quality of care...
Example: Why SDM mattersProstate cancer treatment choices:Wilt T et al. Radical Prostatectomy versusObservation for Locali...
Health literacy: Foundation of SDM          Capacity to          • Read          • Write          • Compute**          • U...
Literacy skills of American adults• 43% Basic or below  basic prose literacy skills• 55% Basic or below  basic numeracy sk...
Health literacy affects… everyone                      Limited                        • knowledge                        •...
Most vulnerable population groups                  Adults who are:                  • Older (esp. ages 65+)               ...
The other half of health literacy:              System demands                                 HealthConsumer Literacy Ski...
Literacy & numeracy challenges            expand in SDM• Amount and complexity of information  (cognitive load)• Unfamilia...
Helping patients understandUse proven tools and methods 1. Plain language and    plain numbers 2. Clear data displays and ...
1. Plain languageGoal:  cognitive effort• Limit content• Structure/organize• Write in clear, everyday terms  [‘chances’ i...
Example from Making the Choice              www.ProstateCancerDecision.org
Web Example: Cancer Research Choices
Plain numbers• Frequencies, maybe % - not decimals,  not fractions, not ratios• Baseline risk• Absolute, not just relative...
Relative vs absolute risk• Relative Risk:  – “Patients who used our miracle drug every day    increased improved their cha...
Constant denominators and “framing” • Denominators   – Choose 100 or 1000 when possible and use     consistently to compar...
2. Visual Displays of DataBest practices  – Numbers  – Icon display  – Simple graph  – Instructions on a table       From ...
Risk chart from Fagerlin, Zikmund-Fisher, Ubel. JNCI, October 2011.
Fagerlin A and Peters E in FDA Guide, p 59
Web-based Graphical display                From Adjuvant online:                Displays estimated                survival...
Matrix DisplayMaking the Choice at www.ProstateCancerDecision.org
Values Clarification Web-Based
Values Clarification Summary
Print version of same exercise
Learn More             www.cancer.gov
3. Narrative examples framed with care  • May help with accurate mental models    and ‘gist’ understanding  • Can introduc...
4. Coaching, Teachback,         “Guided Imagery”                     Verbal exchange structured                     to max...
5. User Engagement•“Collaborative composing” (Zarcadoolas)• User-centered design (usability.gov)• Audience testing
Do “solutions” work?       Evidence: “Yes…but”       • Understanding  with        better material design       • Understa...
Resource Support• Research literature (Medical Decision Making)• IPDAS – International Patient Decision Aid  Standards• Pr...
Summing Up: A Recap• Only 12% of adults have Proficient  health literacy skills• Health information with numbers is  hard ...
Sue Stableford - Health literacy, numeracy and shared decisionmaking
Upcoming SlideShare
Loading in...5
×

Sue Stableford - Health literacy, numeracy and shared decisionmaking

531

Published on

Presented by Sue Stableford, MPH, MSB, on September 7, 2012 at the third annual Center for Health Literacy Conference: Plain Talk in Complex Times.

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
531
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
20
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Sue Stableford - Health literacy, numeracy and shared decisionmaking"

  1. 1. Health Literacy, Numeracy and Shared Decisionmaking Sue Stableford, MPH, MSB, Director University of New England Health Literacy Institute Portland, Maine sstableford@une.edu
  2. 2. Preview • ACA and shared decisionmaking • Health literacy, numeracy, and risk communication • Challenges and emerging solutions for decision aids • Need for research and action • ResourcesCover: IOM report - Health Literacy Implications for Health Care Reform
  3. 3. Affordable Care Act Sec 3506Program to Facilitate Shared Decision-Making“…facilitate collaborative processes between patients, caregivers or authorized representatives, and clinicians that engages … in decisionmaking, provides … information about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan”
  4. 4. Shared decisionmaking (SDM)• Key concept: “Preference-sensitive” care – Possible harms and benefits closely matched – Patient values play critical role• Decisions: – Screening (e.g. PSA) – Treatment (e.g. breast cancer)• Decision “aids” or “supports”
  5. 5. Shared decisionmaking enhances care quality• Linked with – patient-centered care – safety and quality of care – medical home model of care – patient satisfaction• Do all patients want to share decisions?
  6. 6. Example: Why SDM mattersProstate cancer treatment choices:Wilt T et al. Radical Prostatectomy versusObservation for Localized Prostate Cancer.N Engl J Med, July 2012.– 12 year randomized clinical trial of low-risk disease patients– Surgery did not reduce all-cause or prostate-cancer mortality– Urinary incontinence and erectile dysfunction significantly more common with surgery
  7. 7. Health literacy: Foundation of SDM Capacity to • Read • Write • Compute** • Understand • Communicate • Use health information
  8. 8. Literacy skills of American adults• 43% Basic or below basic prose literacy skills• 55% Basic or below basic numeracy skills Health literacy skills: 12% Proficient
  9. 9. Health literacy affects… everyone Limited • knowledge • skills • time Often, poor • health • vision or hearing • support system
  10. 10. Most vulnerable population groups Adults who are: • Older (esp. ages 65+) • Hispanic/Latino • Immigrants • Poor • Managing a chronic physical or mental health condition
  11. 11. The other half of health literacy: System demands HealthConsumer Literacy Skills Literacy Complex System Demands Challenge Adapted from IOM conceptual framework in “Health Literacy: A Prescription to End Confusion”, 2003
  12. 12. Literacy & numeracy challenges expand in SDM• Amount and complexity of information (cognitive load)• Unfamiliar numeracy concepts (statistical risk)• Uncertainty of outcome applied to self• Emotional complexity• Possible poor health and depression
  13. 13. Helping patients understandUse proven tools and methods 1. Plain language and plain numbers 2. Clear data displays and values clarification strategies 3. Narrative examples 4. ‘Coaching’ and Teachback 5. User engagement www.FDA.gov
  14. 14. 1. Plain languageGoal:  cognitive effort• Limit content• Structure/organize• Write in clear, everyday terms [‘chances’ instead of ‘risk’]• Design for fast visual access• Consider culture
  15. 15. Example from Making the Choice www.ProstateCancerDecision.org
  16. 16. Web Example: Cancer Research Choices
  17. 17. Plain numbers• Frequencies, maybe % - not decimals, not fractions, not ratios• Baseline risk• Absolute, not just relative, risk• Denominators and time frames constant for comparison• Positive and negative frames Fagerlin A, Zikmund-Fisher B, Ubel P. Helping Patients Decide: Ten Steps to Better Risk Communication. JNCI, 2011. 103:1436-43 Woloshin S and Schwartz LM. Communicating Data About the Benefits and Harms of Treatment: A Randomized Trial. Ann Intern Med, 2012.
  18. 18. Relative vs absolute risk• Relative Risk: – “Patients who used our miracle drug every day increased improved their chances of ___ by 50%.” (no baseline, no timeframe)• Absolute Risk: – “When used daily for a year, our miracle drug increased the chances of ___ from 1 in 100 to 2 in 100” (or from 1% to 2%)
  19. 19. Constant denominators and “framing” • Denominators – Choose 100 or 1000 when possible and use consistently to compare treatments or outcomes • Framing: Positive and negative – “50 out of 1000 women (or 5%) who take this drug get a skin rash. This means that 950 (or 95%) do not.”
  20. 20. 2. Visual Displays of DataBest practices – Numbers – Icon display – Simple graph – Instructions on a table From AHRQ consumer booklet: “ACE Inhibitors” and “ARBs” To Protect Your Heart? A Guide for Patients Being Treated for Stable Coronary Heart Disease
  21. 21. Risk chart from Fagerlin, Zikmund-Fisher, Ubel. JNCI, October 2011.
  22. 22. Fagerlin A and Peters E in FDA Guide, p 59
  23. 23. Web-based Graphical display From Adjuvant online: Displays estimated survival and mortality risks for breast cancer patients deciding among adjuvant therapy choices
  24. 24. Matrix DisplayMaking the Choice at www.ProstateCancerDecision.org
  25. 25. Values Clarification Web-Based
  26. 26. Values Clarification Summary
  27. 27. Print version of same exercise
  28. 28. Learn More www.cancer.gov
  29. 29. 3. Narrative examples framed with care • May help with accurate mental models and ‘gist’ understanding • Can introduce bias • Can overpower data – Disproportionate effect on adults with limited numeracy skills
  30. 30. 4. Coaching, Teachback, “Guided Imagery” Verbal exchange structured to maximize understanding • Clinician explains: “Choice, option and decision talk” (Elwyn) • Patient tells or demonstrates • Clinician re-explains as needed • Use of written or media tools (decision aids or DAs)Elwyn G et al. J Gen Intern Med, 2012Wolf M. Chpt 9, Health Literacy, in FDA Guide, Communicating Risks and Benefits
  31. 31. 5. User Engagement•“Collaborative composing” (Zarcadoolas)• User-centered design (usability.gov)• Audience testing
  32. 32. Do “solutions” work? Evidence: “Yes…but” • Understanding  with better material design • Understanding risk  if consistent denominators and icon displays used • Understanding  with professional support
  33. 33. Resource Support• Research literature (Medical Decision Making)• IPDAS – International Patient Decision Aid Standards• Professional and University-based groups – SMDM: Society for Medical Decision Making – Shared decision centers; e.g. Ottawa and Dartmouth• PCORI – Patient-Centered Outcomes Research Institute (ACA)
  34. 34. Summing Up: A Recap• Only 12% of adults have Proficient health literacy skills• Health information with numbers is hard for most to understand• SDM adds extra demands and complexity• Lowering the burden to understand can help patients engage with providers in wiser care choices• Best practice is evolving. We can use current guidelines.
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×