1.
Patient-centered dissemination of
evidence-based medicine
A Journey Toward Shared Decision Making

2.
Encounter Research

3.
Weymiller et al. Arch Intern Med 2007
Statin Choice
Web

4.
Compared to usual care,
patients using the decision aid were
22 times more likely
to have an accurate sense of their baseline
risk and risk reduction with statins.
Weymiller et al. Arch Intern Med 2007

5.
Osteoporosis Choice
Montori et al, AJM 2011

6.
AMI Choice

7.
Chest Pain Choice
Hess et al. Circ 2012

8.
Mullan et al, Arch Intern Med 2009
Diabetes Medication Choice
Video / Web

9.
Depression Medication Choice
LeBlanc 2012

10.
Examples
Decision aid Evaluation
Risk communication tools
Statin Choice (primary care) Feasible, effective
Independently validated
Multicenter trial completed
Implemented in EHR
Chest pain Choice (emergency) Feasible, effective (Emergency)
Multicenter trial seeking funding
Aspirin Choice (primary care) Implemented in EHR without evaluation
Osteoporosis Choice (primary care) Feasible, effective
EHR implementation ongoing
PCI Choice (cardiology) Ongoing
AMI Choice (hospital) Feasible, effective (hospital)
Issue cards
DM2 Med Choice Feasible, effective
Multicenter trial ongoing
Implemented in EHR
Depression Choice Ongoing

11.
The body of evidence
Systematic review of 115 RCTs
Compared to usual care, decision aids:
Increase patient involvement by 34% (+++-)
Increase patient knowledge of options by 13% (++++)
Increase consultation time by ~2.6 minutes
Reduce decisional conflict by ~7%
Reduce % undecided by 40%
No consistent effect on choice, adherence,
health outcomes or costs
Stacey D et al. Cochrane review 2014

12.
Summary of Mayo experience
Age: 40-92 (avg 65)
Primary care, ED, hospital, specialty care
74-90% clinicians want to use tools again
Adds ~3 minutes to consultation
60% fidelity without training
20% improvement in patient knowledge
17% improvement in patient involvement
Variable clinical outcomes

13.
Conclusions
• It is feasible to promote evidence-based
conversations during the clinical encounters
with patients with chronic conditions.
• Decision aids designed for this purpose are
efficient and effective in promoting shared
decision making.
• Tools tested in randomized trials and proven
effective are available for free.
• Partners to get to routine use in practice.

14.
ShareEBM
Patient-centered dissemination of evidence-based medicine
http://www.share-ebm.org/
Mayo Clinic KER Unit (http://shareddecisions.mayoclinic.org)
Institute for Clinical Systems Improvement (https://www.icsi.org/)