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Shared decision making: Changing the relationship between doctor and patient
This document discusses shared decision making between doctors and patients. It defines shared decision making as a process where doctors and patients make medical decisions together by considering evidence-based treatment options, their risks and benefits, and the patient's values and preferences. The document notes that while shared decision making improves health outcomes, many patients are not aware they have treatment choices and doctors do not always discuss patient preferences. It argues we need decision support tools, reliable patient information from various sources, and ways to effectively deliver this information to patients to facilitate shared decision making in clinical practice.
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Shared decision making: Changing the relationship between doctor and patient
- 1. SHARED DECISION MAKING: CHANGING THERELATIONSHIP 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: WhyShared 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: SHAREDDECISION MAKING WHAT AND WHY? SANDRA VAN DULMEN GLYNN ELWYN
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- 6. SDM in context Prof.dr. Sandra van Dulmen eHealth week 2016 Amsterdam
- 7. Imagine having tomake preference sensitive treatment decisions • Depression • COPD
- 8. Prerequisites for three-talkmodel Patient - Understanding - Participation - Role in decision-making Physician - Attitude - Tailoring - Patient experiences Interaction - Time - Values, preferences and emotions - Respect
- 9. Web-based decision supporttools - 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 dailyclinical 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: SHAREDDECISION MAKING WHAT DO WE NEED? TON DRENTHEN PAULINE DE HEER MARKUS OEI
- 12. PLAY 2 “COMMONPRACTISE” SDM
- 13. Decision aids asan 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 in1956 • 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
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- 20. Effect Thuisarts.nl atdoctor’s visit Did visit GPDid not visit GP Huisarts & Wetenschap mei 2015
- 21. Future • Addition withspecialist medical information • More decision aids and option grids • Multimedia: more videos and images • Extension to eHealth platform: – Making appointments – Linking patient records – Etc.
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- 23. Improving information availability forpatients The role of the government Pauline de Heer eHealth week, 9 June 2016
- 24. 24 National Health CareInstitute (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: Providinguser-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.
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- 28. 28 Other activities tohelp 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 tothe 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: SHAREDDECISION MAKING IN CLINICAL PRACTICE
- 33. Shared decision making: Hereand now Dr. Marleen Vleming, MD, PhD, ENT-surgeon Dr. Markus Oei, MD, PhD, ENT-surgeon
- 34. Results • High patientsatisfaction • Patients choose more conservatively • 25% less operations
- 35. SHARED DATABASE OFMEDICAL INFORMATION AND DECISION AIDS TRANSMURAL, REGIONAL, STANDARD PATIENT INFORMATION TOOL MAY 2016-APRIL 2017 PROJECT CHIP- CONNECTED HEALTH INFORMATION PLATFORM: PUTTING IT ALL TOGETHER
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- 37. CITY OF ALMERE 8THLARGEST 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 • NATIONALORGANIZATIONS: 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 ITFOR 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)
- 40. CONNECTED HEALTH INFORMATION PLATFORM MAY2016-APRIL 2017
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- 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 TECHNOLOGIESCOME 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 SHARETHIS SESSION? •INFORIUM.EU OR INFORIUM.NL • CODE: EHW2016 • YOUR EMAIL ADDRESS (DON’T WORRY ABOUT PRIVACY, IT IS NOT STORED)