Myths of Shared Decision Making - ISDM 2011 Maastricht, Netherlands

Challenging myths: Empathic decision making in usual clinical settings
Victor M. Montori, MD, MSc
KER UNIT, Mayo Clinic

Decision making models
Modified from Charles C et al

Desired clinical behavior
EMPATHIC DECISION MAKING
Partnership
Dance across models

Wiser Choices Program
at Mayo Clinic’s KER UNIT
http://kercards.e-bm.info

Settings (bold = RCT)

Statin Choice
Weymiller et al. Arch Intern Med 2007

Osteoporosis Choice
Montori et al, AJM 2011

Diabetes Medication Choice
Mullan et al, Arch Intern Med 2009

AMI Choice

Chest Pain Choice

Participants
* Would like to use it again with other patients considering the same decision?

Ethical
Legal
Success of the decision aid
Knowledge transfer
Creates a conversation
Fit
Economic
Effectiveness

Implementation
Understandable
Doable
Favorable
Fit for purpose, users, setting
http://normalizationprocess.org

Statin Decision Aid

Lessons learnt
User-centered design happens in the field, takes multiple iterations and expertise.
Testing decision aids in usual clinical settings is tough: decision moments are unpredictable.
Repeated use for chronic decisions has been difficult to study in efficacy trials.

Myths
Goal and settings
Decision aids have no role in evidence-based care
Decision aids support shared decision making
Valid decision aids cannot be used in busy clinical settings, such as primary care
Participants
Clinicians would not want to use decision aids – they are barriers to adoption of SDM
Acutely ill patients are not good targets for SDM
Elderly chronically ill patients cannot participate in SDM

Summary of 5 years of work
13 wiser choices decision aids
Chronic and acute care
Primary and specialty care
Rural, urban, and academic
50+ sites
200+ clinicians
600+ patients
In trials!

montori.victor@mayo.edu
http://kerunit.e-bm.org
http://kercards.e-bm.info
http://shareddecisions.mayoclinic.org
@vmontori

Myths of Shared Decision Making - ISDM 2011 Maastricht, Netherlands

by Victor Montori on Jun 27, 2011

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