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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

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