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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
PLAY 1 (THE “OLD FASHIONED
WAY”)
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?
PART 1: SHARED DECISION
MAKING
WHAT AND WHY?
SANDRA VAN DULMEN
GLYNN ELWYN
E-HEALTH EXAMPLE 1
SDM in context
Prof. dr. Sandra van Dulmen
eHealth week 2016 Amsterdam
Imagine having to make preference
sensitive treatment decisions
• Depression
• COPD
Prerequisites for three-talk model
Patient
- Understanding
- Participation
- Role in decision-making
Physician
- Attitude
- Tailoring
- Patient experiences
Interaction
- Time
- Values, preferences and emotions
- Respect
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
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…
PART 2: SHARED DECISION
MAKING WHAT DO WE NEED?
TON DRENTHEN
PAULINE DE HEER
MARKUS OEI
PLAY 2 “COMMON PRACTISE” SDM
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
• 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)
Shared decision making: Changing the relationship between doctor and patient
Use of
• 75% of Dutch GPs use it in their consultation
• 60.000-90.000 visits a day
Shared decision making: Changing the relationship between doctor and patient
Example: decision aid
Shared decision making: Changing the relationship between doctor and patient
Effect Thuisarts.nl at doctor’s visit
Did visit GPDid not visit GP
Huisarts & Wetenschap mei 2015
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.
t.drenthen@nhg.org
Improving information
availability for patients
The role of the government
Pauline de Heer
eHealth week, 9 June 2016
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
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
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.
27
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
Bringing the information
to the patient:
the missing link
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 ??
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
PART 3: SHARED DECISION
MAKING IN CLINICAL
PRACTICE
Shared decision
making: Here and now
Dr. Marleen Vleming, MD, PhD, ENT-surgeon
Dr. Markus Oei, MD, PhD, ENT-surgeon
Results
• High patient satisfaction
• Patients choose more conservatively
• 25% less operations
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
PARTNERS
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
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
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)
CONNECTED HEALTH INFORMATION
PLATFORM
MAY 2016-APRIL 2017
WRAP-UP
TAKE HOME MESSAGES (1)
• SHARED DECISION MAKING
• REQUIRES A CHANGE IN ATTITUDE FROM PATIENT AND
DOCTOR
• IS ETHICAL
• IMPROVES QUALITY OF HEALTH
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
SHARED DECISION MAKING = SHARED
HEALTH CARE
• SHARED ATTITUDE
• SHARED EFFORT
• SHARED CONTENT
• SHARED RESOURCES
• SHARED TOOLS
• SHARED RESPONSIBILITY
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.
REPEAT AND SHARE THIS
SESSION?
•INFORIUM.EU OR
INFORIUM.NL
• CODE: EHW2016
• YOUR EMAIL ADDRESS (DON’T WORRY ABOUT PRIVACY, IT IS
NOT STORED)

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Shared decision making: Changing the relationship between doctor and patient

  • 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
  • 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)
  • 16. Use of • 75% of Dutch GPs use it in their consultation • 60.000-90.000 visits a day
  • 20. Effect Thuisarts.nl at doctor’s visit Did visit GPDid not visit GP Huisarts & Wetenschap mei 2015
  • 21. 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.
  • 23. Improving information availability for patients The role of the government Pauline de Heer eHealth week, 9 June 2016
  • 24. 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
  • 25. 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
  • 26. 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.
  • 27. 27
  • 28. 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
  • 29. Bringing the information to the patient: the missing link
  • 30. 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 ??
  • 31. 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
  • 32. PART 3: SHARED DECISION MAKING IN CLINICAL PRACTICE
  • 33. Shared decision making: Here and now Dr. Marleen Vleming, MD, PhD, ENT-surgeon Dr. Markus Oei, MD, PhD, ENT-surgeon
  • 34. Results • High patient satisfaction • Patients choose more conservatively • 25% less operations
  • 35. 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
  • 37. 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
  • 38. 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
  • 39. 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)
  • 42. TAKE HOME MESSAGES (1) • SHARED DECISION MAKING • REQUIRES A CHANGE IN ATTITUDE FROM PATIENT AND DOCTOR • IS ETHICAL • IMPROVES QUALITY OF HEALTH
  • 43. 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
  • 44. SHARED DECISION MAKING = SHARED HEALTH CARE • SHARED ATTITUDE • SHARED EFFORT • SHARED CONTENT • SHARED RESOURCES • SHARED TOOLS • SHARED RESPONSIBILITY
  • 45. 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.
  • 46. REPEAT AND SHARE THIS SESSION? •INFORIUM.EU OR INFORIUM.NL • CODE: EHW2016 • YOUR EMAIL ADDRESS (DON’T WORRY ABOUT PRIVACY, IT IS NOT STORED)