1.
SHARED DECISION
MAKING: CHANGING
THE RELATIONSHIP
BETWEEN DOCTOR &
PATIENT
MARKUS OEI
SANDRA VAN DULMEN
GLYN ELWYN
TON DRENTHEN
PAULINE DE HEER
MARLEEN VLEMING & SUSANNE SUZOR-VAN ZWICHT

2.
PLAY 1 (THE “OLD FASHIONED
WAY”)

3.
PROGRAM
Part 1: Why Shared Decision Making and what is it?
Part 2: What resources and eHealth tools do we need?
Part 3: How can we use it in clinical practice?

4.
PART 1: SHARED DECISION
MAKING
WHAT AND WHY?
SANDRA VAN DULMEN
GLYNN ELWYN

5.
E-HEALTH EXAMPLE 1

6.
SDM in context
Prof. dr. Sandra van Dulmen
eHealth week 2016 Amsterdam

7.
Imagine having to make preference
sensitive treatment decisions
• Depression
• COPD

8.
Prerequisites for three-talk model
Patient
- Understanding
- Participation
- Role in decision-making
Physician
- Attitude
- Tailoring
- Patient experiences
Interaction
- Time
- Values, preferences and emotions
- Respect

9.
Web-based decision support tools
- Video Zorgkeuzelab
- Decision support tools enhance patient involvement1 and force
- Physicians to attend to patient values and preferences
- Patients to think about their values and preferences
- Decision support tools1
- Increase knowledge and risk perception
- Decrease decisional conflict
- As a result, better adherence and quality of life2 and less
invasive tests3 1 Van Weert et al, 2016
2 Stacey et al, 2008
3 Knops et al, 2013

10.
Meanwhile in daily clinical practice….
-Many patients have no idea that they have a
choice
-Medical arguments weight more in decision-
making than patient preferences
-Physicians do not inquire about their values and
preferences in 1/5 of the visits
-30% of patients want their physician to make the
decision, especially when being seriously ill, even
then…

11.
PART 2: SHARED DECISION
MAKING WHAT DO WE NEED?
TON DRENTHEN
PAULINE DE HEER
MARKUS OEI

12.
PLAY 2 “COMMON PRACTISE” SDM

13.
Decision aids as an integrated part of a
website with evidence-/guideline-based
information on health and disease
Ton Drenthen, PhD
Dept. Prevention and Patient education
Dutch College of GPs
Amsterdam, June 9, 2016

14.
• Founded in 1956
• 90% of GPs is member of NHG (>11.000 members)
• Mission: support and improve evidence-based
general practice
• One of the activities: supporting GPs in patient
education
Dutch College of General Practitioners
(NHG)

15.
Use of
• 75% of Dutch GPs use it in their consultation
• 60.000-90.000 visits a day

16.
Example: decision aid

17.
Effect Thuisarts.nl at doctor’s visit
Did visit GPDid not visit GP
Huisarts & Wetenschap mei 2015

18.
Future
• Addition with specialist medical information
• More decision aids and option grids
• Multimedia: more videos and images
• Extension to eHealth platform:
– Making appointments
– Linking patient records
– Etc.

19.
t.drenthen@nhg.org

20.
Improving information
availability for patients
The role of the government
Pauline de Heer
eHealth week, 9 June 2016

21.
24
National Health Care Institute
(Zorginstituut Nederland in Dutch)
Main tasks:
• Coverage of the Health Insurance Act and Long-Term Care Act
• Risk adjustment for Health Insurance companies
• Facilitating good health care and quality improvement
• Reviewing health care professions and education, and future needs

22.
25
Health Care Quality: facilitating good health care
• Contributes to good health care by helping
– parties involved to continually improve health care quality
– patients find their way to good-quality care
• Makes quality transparent
– Care-providers measure the outcomes of care, based on quality
standard
– Health Care Quality programme publishes quality information
› public database with open data
› kiesBeter.nl for patients

23.
26
Website kiesBeter.nl (chooseBetter)
Aim:
Providing user-friendly access to information on good health care
in the Netherlands
Providing access: referring where possible, otherwise offer information
ourselves
Focus on good health care:
• What is good health care?
• Where can I find good health care? (quality of health care providers)
+
• Where can I find other trustworthy information?
Currently 175 pages on diseases
and 10 guides to health care themes
Currently information on 2,000
health care organisations
within 7 sectors
Currently links to more than 2,000
guidelines, websites, option grids, etc.

24.
27

25.
28
Other activities to help patients get good information
• Support and cooperate with (patient) organisations to improve and
share their patient information
• Public database with open data on quality of health care
• All KiesBeter pages are shared with Betrouwbare Bron and Inforium

26.
Bringing the information
to the patient:
the missing link

27.
Focus shift : to doctor-patiënt
Information
Decision aids
App(lication)s
Shared Database
Doctor
Patiënt
But everybody uses
email! (80-100%)
Acceptance:
Personal health record 0-10 %
Health portal 0-10%
Apps ??

28.
Features and acceptance
• Very easy to use (for doctor and patiënt )
• Privacy issues solved
• accepted by hospital security officers, privacy experts and organizations
• Acceptance by patiënts: over 80% (92% in our clinic)
• Patiënts love it
• Rating over 8
• Several nominations/ awards

29.
PART 3: SHARED DECISION
MAKING IN CLINICAL
PRACTICE

30.
Shared decision
making: Here and now
Dr. Marleen Vleming, MD, PhD, ENT-surgeon
Dr. Markus Oei, MD, PhD, ENT-surgeon

31.
Results
• High patient satisfaction
• Patients choose more conservatively
• 25% less operations

32.
SHARED DATABASE OF MEDICAL
INFORMATION AND DECISION AIDS
TRANSMURAL, REGIONAL,
STANDARD PATIENT INFORMATION
TOOL
MAY 2016-APRIL 2017
PROJECT CHIP- CONNECTED
HEALTH INFORMATION
PLATFORM:
PUTTING IT ALL TOGETHER

33.
PARTNERS

34.
CITY OF ALMERE
8TH LARGEST CITY IN THE NETHERLANDS
POPULATION 200.000
START IMPLEMENTATION JUNE 2016
• 50% OF THE GENERAL PRACTITIONERS
• 80% PHARMACIES
• 25% PHYSIOTHERAPISTS
• 30% FLEVOZIEKENHUIS (HOSPITAL)
• OTHER HEALTH DISCIPLINES
• SCALE-UP OTHER REGIONS

35.
SHARED DATABASE
• NATIONAL ORGANIZATIONS: DECISION AIDS AND RELIABLE HEALTH
INFORMATION
• GOVERNMENTAL
• MEDICAL
• NON-PROFIT ORGANIZATIONS
• PATIENT ORGANIZATIONS
• LOCAL ORGANIZATIONS: LOCAL INFORMATION
• FLEVOZIEKENHUIS (HOSPITAL)
• ALMERE CARE GROUP (HOME PHYSICIANS, PHARMACISTS, PHYSIOTHERAPISTS)
• OTHER PROFESSIONALS
• HEALTH PROFESSIONALS: SHARE ACCESS TO HEALTH INFORMATION AND
DECISION AIDS

36.
WHAT’S IN IT FOR THE PATIENT?
• TAILORED INFORMATION FOR MORE GRIP AND UNDERSTANDING OF HIS DISEASE AND
TREATMENT OPTIONS
• A PATIENT INFORMATION RECORD (NOT PHR) IN HIS OWN MAILBOX, APPLICATION OR APP
• PATIENT IS THE CORE (OWNER)
• CAN DECIDE TO SHARE, DELETE, STORE ALL RECEIVED INFORMATION
• IT’S FREE!
• TRANSMURAL USAGE
• MEDICAL INFORMATION/DECISION AIDS SENT BY ALL HEALTH
PROFESSIONALS/ORGANIZATIONS
• COÖRDINATED INFORMATION
• GATEWAY TO MEDICAL APPS, APPLICATIONS, PORTALS, PERSONAL HEALTH RECORDS (PHR)

37.
CONNECTED HEALTH INFORMATION
PLATFORM
MAY 2016-APRIL 2017

38.
WRAP-UP

39.
TAKE HOME MESSAGES (1)
• SHARED DECISION MAKING
• REQUIRES A CHANGE IN ATTITUDE FROM PATIENT AND
DOCTOR
• IS ETHICAL
• IMPROVES QUALITY OF HEALTH

40.
TAKE HOME MESSAGE (2)
• SHARED DECISION MAKING
• NEEDS RELIABLE, REPEATABLE, UNDERSTANDABLE CONTENT
AND DECISION AIDS
• NEEDS SUPPORT FROM ALL HEALTH ORGANIZATIONS AND
GOVERNMENT
• NEEDS TO REACH THE PATIENT

41.
SHARED DECISION MAKING = SHARED
HEALTH CARE
• SHARED ATTITUDE
• SHARED EFFORT
• SHARED CONTENT
• SHARED RESOURCES
• SHARED TOOLS
• SHARED RESPONSIBILITY

42.
MISSION
• NEW TECHNOLOGIES COME WITH GREAT OPPORTUNITIES,
BUT ALSO WITH THE RISK OF PRESENTING PEOPLE WITH AN
OVERLOAD OF INFORMATION. WE TOGETHER HAVE TO
DESIGN SUPPORTING MATERIALS AND METHODS IN A SUCH
A WAY THAT SHARED DECISION-MAKING IS TRULY
SUPPORTED.

43.
REPEAT AND SHARE THIS
SESSION?
•INFORIUM.EU OR
INFORIUM.NL
• CODE: EHW2016
• YOUR EMAIL ADDRESS (DON’T WORRY ABOUT PRIVACY, IT IS
NOT STORED)