Toward The ‘Tipping Point’: Decision Aids And Informed Patient Choice

O’Connor, Annette M.; Wennberg, John E.; Llewellyn‐Thomas, Hilary A.; Moulton, Benjamin W.; Sepucha, Karen; Sodano, Andrea G.; King, Jaime S.

doi:10.1377/hlthaff.26.3.716

Cited by 395 publications

(337 citation statements)

References 17 publications

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“…10 The term SDM is often used inconsistently. 11,12 The following elements characterize our understanding of SDM [13][14][15][16][17][18] : SDM may (and should) be employed in life-threatening disease, where biomedical factors far outweigh placebo effects in determining the outcome. Nevertheless, physicians frequently encounter treatment decisions involving chronic and self-limited illnesses.…”

Section: Introductionmentioning

confidence: 99%

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

2012

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Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient's experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and "outcome engineering" in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.

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Section: Introductionmentioning

confidence: 99%

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

2012

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“…We found that patients frequently expressed treatment preferences that differed from guideline recommendations; although medication was typically the intervention that would yield the greatest reduction in risk, the majority of patients preferred dietary and other lifestyle changes to reduce their risk. This highlights the importance of the SDM process itself; SDM should ideally allow the provider to design a "preference-sensitive" [13] treatment approach that reflects activities that patients want and are likely to do. Where the gap between patient's preferences (e.g., where the patient indicates they do not want to do anything) and the evidence is significant, the provider has the opportunity to educate the patient.…”

Section: Discussionmentioning

confidence: 99%

Shared decision making: using health information technology to integrate patient choice into primary care

Jones

Bruce

Shah

et al. 2011

Behav. Med. Pract. Policy Res.

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Advances in shared decision making (SDM) have not successfully translated to practice. We describe our experience and lessons learned in translating an SDM process for primary care cardiovascular disease management. The SDM process operationalized recognized SDM elements using workflow modifications, a computerized patient questionnaire, an automated risk calculator to identify at-risk patients, a web-based tool for patients to choose interventions, automated feedback on the personalized benefits of choices, and a web-based tool for providers to view patient risk, patient choice, and expert advice. Although medication was typically the intervention resulting in the greatest risk reduction, the majority of patients preferred dietary and other lifestyle changes. Patients generally favored the opportunity to make and communicate choices. However, providers only viewed patient choice data in 20% of the encounters. Translation of the SDM process was successful for patients and the difference between patient choice and optimal risk reduction points to the importance of engaging in an SDM process. Lack of engagement by providers may be due to "alert fatigue" or to the failure of the SDM process to improve efficiency in the office visit. KeywordsShared decision making, Translation, e-Technology BACKGROUND Shared decision making (SDM) is widely recognized as a desirable form of patient-provider interaction [1][2][3]. In theory, the SDM process seems straightforward. In practice, there is limited success in translating tested SDM protocols to routine clinical practice [4,5].SDM tools (e.g., a decision aid) and processes are intended to foster a consideration of the risk, benefits, and tradeoffs associated with a decision, and the way in which a patient's preferences are incorporated into the discussion and decision process [6,7]. There is growing interest in conceptual models, methods for communicating information, and tests of the utility and impact of tools and processes. There has been relatively little focus, however, on how SDM tools and processes can be successfully deployed and integrated into clinical practice. In general, SDM has not been

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“…25,26 Theoretically, placing the information about screening into a broader context of personal values enables parents to identify choices inconsistent with their values and thus reject them. 32 The magnitude of the reduction in study participation was surprising even though previous research has also reported significant drops in acceptance rates. For example, a study investigating the use of a decision aid about bowel cancer screening showed that the decision aid was associated with higher knowledge and greater confidence in decisions but reduced participation in fecal occult blood testing from 75 to 59%.…”

Section: Original Research Articlementioning

confidence: 93%