Glyn Elwyn, Shared Decision Making... a dangerous idea
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April 18, 2018 Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification. For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
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Glyn Elwyn, Shared Decision Making... a dangerous idea
- 2. Professor Glyn Elwyn BA MD MSc PhD @glynelwyn
- 5. Past advisor to Healthwise, Foundation for Informed Medical Decision Making, National Quality Forum, USA. Founder of Option Grid TM patient decision aids, now licensed to EBSCO Health. Financial Interests
- 6. A few questions ● What is shared decision making? ● Can it be measured? ● Why bother? ● Can it be taught? ● What might help it catch on?
- 7. What is it?
- 9. I prefer this option ...
- 10. What is it?
- 11. Helping a person develop an informed preference
- 12. Shared decision making An approach where clinicians and patients make decisions together, using the best available evidence to deliberate about the likely benefits and harms, and where patients are supported to arrive at informed preferences. Elwyn G, Frosch D, et al. Shared decision making: a model for clinical practice. J Gen Internal Medicine 2012;10:1361–7.
- 13. It is not ...
- 14. ● Making patients decide ● Giving patients what they want ● An evidence-free zone
- 15. When to share decisions ● Where reasonable alternatives exist ● Where patient-relevant trade-offs between harm and benefit exist ● Where patients have opinions
- 16. When not to share ● Where there is no time to deliberate ● Where there is no decision-making capacity ● When the patient does not want to make a decision ? Overwhelming evidence of benefit
- 18. 0 1 2 3 4 5 6 7 8 9 No effort was made Every effort was made How much effort was made to help you understand your health issues?
- 19. 0 1 2 3 4 5 6 7 8 9 No effort was made Every effort was made How much effort was made to listen to the things that matter most to you about your health issues?
- 20. 0 1 2 3 4 5 6 7 8 9 No effort was made Every effort was made How much effort was made to include what matters most to you in choosing what to do next?
- 21. Top Box Score Collect scores from a minimum of 25 patients Calculate a Top Box Score What % of patients give the top score Item 1 = 9 Item 2 = 9 Item 3 = 9 Top Score = % of patients give a score of 27.
- 22. Top Box Score Mean Score 63% Score Range 45 - 87%
- 23. Elwyn G, Barr PJ, Grande SW, Thompson R, Walsh T, Ozanne EM. Developing CollaboRATE: A fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Educ Couns. 2013 Jun 11;93(1):102–7. Barr PJ, Thompson R, Walsh T, Grande S, Ozanne E, Elwyn G. The psychometric properties of CollaboRATE. A fast and frugal patient-reported measure of the shared decision-making process. J Med Internet Res. 2014 Jan 3;16(1):e2. Barr, P.J. et al., 2017. Evaluating CollaboRATE in a clinical setting: analysis of mode effects on scores, response rates and costs of data collection. BMJ Open, 7(3), p.e014681.
- 24. Other patient reported measures ● SDM-Q9 Hamburg ● Some CAHPS Items ● Patient Involvement in Care ● SDM Process Measure (Surgical)
- 25. Why bother?
- 26. It’s the right thing to do?
- 27. Better outcomes Satisfied patients Better informed patients Better adherence Better decision quality Lower costs Less complaints Less litigation Shay LA et al Where is the evidence? A systematic review of shared decision making outcomes. Med Decis Mak 2015;35:114–31.
- 35. What might help it catch on?
- 36. ● Attitude Shift ● Measurement ● Tools
- 37. Patient decision aids ● Compare reasonable options ● Accurate risk information ● Designed for patients to understand
- 40. Patient decision aids ● Pre-encounter tools ● Encounter tools ● Hybrid tool
- 41. ● Encounter tool
- 42. ● Hybrid tool
- 43. I prefer this option ...
- 45. @glynelwyn