Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.
-
Upload
lynette-johnston -
Category
Documents
-
view
230 -
download
1
Transcript of Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.
![Page 1: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/1.jpg)
Promoting Shared Decision Making
Jack FowlerInformed Medical Decisions
Foundation
![Page 2: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/2.jpg)
Shared decision making means
• 1. Patients are told about all reasonable options
• 2. Patients are told about pros and cons of options
• 3. Patients share goals, concerns and preferences with providers
![Page 3: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/3.jpg)
4 Reasons Not to Increase Efforts to Do Shared Decision Making
• 1. We already do it
• 2. Patients don’t want it
• 3. Patients can’t understand
• 4. Doctors should make decisions
![Page 4: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/4.jpg)
We already do it?
![Page 5: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/5.jpg)
National Survey of Medical Decisions
• Cancer screening tests:– Colorectal Cancer– Breast Cancer (mammography)– Prostate Cancer (PSA testing)
• Prescription medication decisions:– Hypertension– High Cholesterol– Depression
• Surgical interventions:– Knee/hip replacement– Cataracts– Lower back pain
![Page 6: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/6.jpg)
Mean Proportion of Knowledge Items Answered Correctly
69%
49%
34%
43%
37%
17%
32%
49%
25%
0% 50% 100%
High blood pressure
High cholesterol
Depression
Colon cancer
Breast cancer (women)
Prostate cancer (men)
Knee/hip replacement
Cararact
Lower back pain
Medication Initiation:
Cancer screening:
Elective surgery:
![Page 7: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/7.jpg)
Discussion of Pros and Cons- “some” OR “A lot”
82%
83%
79%
73%
75%
69%
90%
76%
72%
31%
34%
39%
14%
13%
16%
49%
33%
62%
0% 50% 100%
High blood pressure
High cholesterol
Depression
Colon cancer
Breast cancer (women)
Prostate cancer (men)
Knee/hip replacement
Cararact
Lower back pain
% Discussed Pros % Discussd Cons
Medication Initiation:
Screened for Cancer:
Underwent surgery:
![Page 8: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/8.jpg)
Did HCP Offer an Opinion and Ask for Patient’s Own Opinion?
84%
85%
78%
84%
80%
80%
85%
78%
82%
41%
45%
74%
34%
38%
46%
77%
61%
76%
0% 50% 100%
High blood pressure
High cholesterol
Depression
Colon cancer
Breast cancer (women)
Prostate cancer (men)
Knee/hip replacement
Cararact
Lower back pain
HCP offered opinion Asked pt. opinion
Medication Initiation:
Screened for Cancer:
Underwent surgery:
![Page 9: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/9.jpg)
PATIENTS DON’T WANT IT?
![Page 10: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/10.jpg)
Testing our First 30-Minute BPH Program
How would you rate the amount of information?
![Page 11: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/11.jpg)
One Universal Truth
• Every time we ask, people (particularly physicians) underestimate how much patients value getting information about their medical conditions and being involved in decisions.
![Page 12: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/12.jpg)
At Dartmouth-Hitchcock
• Patients routinely see decision aids for at least 11 different decisions
• They are surveyed after they see them
![Page 13: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/13.jpg)
Who Should Make Decisions?
Dartmouth patient data collected between July 2005 and July 2009
![Page 14: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/14.jpg)
Would You Recommend DA for Others
Dartmouth patient data collected between July 2005 and July 2009
![Page 15: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/15.jpg)
Patients can’t understand?
![Page 16: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/16.jpg)
Findings with Respect to Literacy
• Compared understanding of risk reduction for samples of college students and senior citizens recruited from community centers
• Both groups were stratified by score on a numeracy test
![Page 17: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/17.jpg)
Percent of Respondents Who Understood Risk Reduction by Numeracy Level and Quality of Data Presentation
![Page 18: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/18.jpg)
Percent of Respondents Who Understood Risk Reduction by Numeracy Level and Quality of Data Presentation
![Page 19: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/19.jpg)
Doctors should make decisions?
![Page 20: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/20.jpg)
Top Three Goals and Concerns for Breast Cancer/Herniated Disc Decisions
Condition: Goal Patient Provider p
Surgery:Keep your breast?
Chemotherapy:Live as long as possible?
Reconstruction:Look natural without clothes
Reconstruction:Avoid using prosthesis
7%
59%
P<0.01
33%
71%
96%
80%
0%
33%
P=0.01
P=0.05
P<0.01
![Page 21: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/21.jpg)
We are not doing it now
![Page 22: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/22.jpg)
Patients do want it
• But many perceive their doctors do not welcome questions and patient participation in decision making
![Page 23: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/23.jpg)
Patients can absorb complex information
• However, it has to be presented well
![Page 24: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/24.jpg)
Decisions should not be delegated to physicians
• Because most medical decisions involve trade offs and quality of life issues
• Providers will not know what patients care about unless they ask
• At the moment, they do not routinely ask
![Page 25: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/25.jpg)
• SO THAT IS WHY WE ALL NEED TO WORK TO PROMOTE THE IDEA THAT PATIENTS ROUTINELY
• SHOULD BE INFORMED ABOUT THEIR OPTIONS AND THEIR PROS AND CONS
• HAVE A VOICE IN MEDICAL DECISIONS
![Page 26: Promoting Shared Decision Making Jack Fowler Informed Medical Decisions Foundation.](https://reader034.fdocuments.net/reader034/viewer/2022042616/56649ddf5503460f94ad83e0/html5/thumbnails/26.jpg)
THANK YOU.