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Myths of Shared Decision Making - ISDM 2011 Maastricht, Netherlands

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Myths of Shared Decision Making - ISDM 2011 Maastricht, Netherlands

  1. 1. Challenging myths: Empathic decision making in usual clinical settings<br />Victor M. Montori, MD, MSc<br />KER UNIT, Mayo Clinic<br />
  2. 2.
  3. 3. Decision making models<br />Modified from Charles C et al<br />
  4. 4. Desired clinical behavior<br />EMPATHIC DECISION MAKING<br />Partnership <br />Dance across models<br />
  5. 5.
  6. 6. Wiser Choices Program<br />at Mayo Clinic’s KER UNIT<br />http://kercards.e-bm.info<br />
  7. 7. Settings (bold = RCT)<br />
  8. 8. Statin Choice<br />Weymiller et al. Arch Intern Med 2007<br />
  9. 9. Osteoporosis Choice<br />Montori et al, AJM 2011<br />
  10. 10. Diabetes Medication Choice<br />Mullan et al, Arch Intern Med 2009<br />
  11. 11. AMI Choice<br />
  12. 12. Chest Pain Choice<br />
  13. 13. Participants<br />* Would like to use it again with other patients considering the same decision?<br />
  14. 14. Ethical <br />Legal<br />Success of the decision aid<br />Knowledge transfer<br />Creates a conversation<br />Fit<br />Economic<br />Effectiveness<br />
  15. 15. Implementation<br />Understandable<br />Doable<br />Favorable<br />Fit for purpose, users, setting<br />http://normalizationprocess.org<br />
  16. 16.
  17. 17. Statin Decision Aid<br />
  18. 18. Lessons learnt<br />User-centered design happens in the field, takes multiple iterations and expertise.<br />Testing decision aids in usual clinical settings is tough: decision moments are unpredictable.<br />Repeated use for chronic decisions has been difficult to study in efficacy trials.<br />
  19. 19. Myths<br />Goal and settings<br />Decision aids have no role in evidence-based care<br />Decision aids support shared decision making<br />Valid decision aids cannot be used in busy clinical settings, such as primary care<br />Participants<br />Clinicians would not want to use decision aids – they are barriers to adoption of SDM<br />Acutely ill patients are not good targets for SDM<br />Elderly chronically ill patients cannot participate in SDM<br />
  20. 20. Summary of 5 years of work<br />13 wiser choices decision aids<br />Chronic and acute care<br />Primary and specialty care<br />Rural, urban, and academic<br />50+ sites<br />200+ clinicians<br />600+ patients<br />In trials!<br />
  21. 21. montori.victor@mayo.edu<br />http://kerunit.e-bm.org<br />http://kercards.e-bm.info<br />http://shareddecisions.mayoclinic.org<br />@vmontori<br />

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