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Enhancing Patient Care through Evidence-Based Shared Decision-Making: Insights from Research

This presentation by Dr. David L. Hahn explores the often-neglected area of evidence-based shared decision-making (EB-SDM). It defines EB-SDM, outlines its essential components, and discusses effective communication strategies, including point-of-service decision aids. Emphasizing the integration of patient values and clinical expertise with the best scientific evidence, the talk highlights the importance of health literacy and the communication dynamics between patients and healthcare providers. Furthermore, it proposes potential research areas to enhance patient outcomes and clinician acceptance of EB-SDM.

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Enhancing Patient Care through Evidence-Based Shared Decision-Making: Insights from Research

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Presentation Transcript

  1. WREN Convocation 2009 Evidence-based shared decision-making(EB SDM)A neglected research topic David L. Hahn, M.D., M.S. (Epidemiology) Dept. Family Practice, Dean Medical Center Clinical Professor, U. Wisconsin Dept. Family Medicine

  2. Evidence-based shared decision-making (EB SDM) • Definition • Components of SDM information • Communicating SDM information • Point of service decision aids • Research areas

  3. Evidence-based shared decision-making (EB SDM) - An integral part of evidence-based practice • “Integration of best research evidence with clinical expertise and patient values.” Sackett, et al, 2000 • Care that meets the needs of patients and is based on the best scientific knowledge. Institute of Medicine

  4. Evidence-based practice

  5. Evidence-based shared decision-making (EB SDM) - Two perspectives • What message is given? • What message is received?

  6. Evidence-based shared decision-making (EB SDM) - Two perspectives • Medical professional • Preferred formats? • Tailored messages? • Patient • Numeracy? • Receptivity?

  7. Evidence-based shared decision-making (EB SDM) - Resources • Cochrane Collaboration • USPSTF • ACP Journal Club • POEMS • FPIN • Others

  8. What message is given? - Preferred formats • DO NOT USE relative terms • Relative risk (RR) • Odds ratios (OR) • % change • Except to illustrate how they can mislead

  9. What message is given? - Preferred formats • Do not depend on some absolute measures • Number needed to treat (NNT) • Number needed to harm (NNH) • Except as secondary explanations • These are more appropriate for clinician decision-making

  10. What message is given? - Preferred formats • DO USE • Baseline events per 100, 1000, 10,000 • Intervention events in identical numerical units • Differences in identical numerical units • ALSO • Use preferred graphical formats

  11. What message is received? • Health literacy • “Receptivity” to SDM • “Willingness to acknowledge the patient as the locus of control”

  12. Health Literacy -The four faces of health communication • What is intended • What is written/said - the symbol • The received meaning - interpretation of the symbol • The power relationship in the communication Andrew Pleasant Phd 2009 Wisconsin Third Biennial Health Literacy Summit

  13. The power relationship in the communication - two approaches • Informative communication • Patient-oriented • Persuasive communication • Not patient-oriented

  14. Informative communication -Aims and methods • Promotes beneficence and autonomy • Encourages shared decision-making • Uses unbiased patient-oriented information • Is understandable and balanced

  15. Persuasive communication - Aims and methods • Manipulates perception and behavior to accomplish an aim • Motivates action via instilling fear • Over-emphasizes/distorts (potential or real) benefits • De-emphasizes/conceals harms/risks

  16. Shared decision-making requires informative communication

  17. Point-of-service decision aids • Simple and straightforward • 6th-8th grade level • Informative • Verbal, tabular and graphical formats • Meant to serve as a basis for discussions during office visits

  18. Point-of-service decision aids -Examples • Example #1 • PSA screening • Example #2 • Mammography between ages 40-49 • Mortality charts

  19. Point-of-service decision aids - Are they really needed? • There are plenty of guidelines already available! • Why reinvent the wheel?

  20. Point-of-service decision aids - Are they really needed? • Beware many clinical practice guidelines • “Pseudo-evidence-based” • United States Preventive Services Task Force (USPSTF) • “B-”rated recommendations • Wisconsin Collaborative for Healthcare Quality (WCHQ) • Mostly SOR “B-” and “C-” level metrics

  21. Point-of-service decision aids - Are they really needed? • Few valid evidence-based guidelines include a “Plain Language Summary” for patients • Cochrane is an exception

  22. Conclusion • EB SDM is a promising topic for practice-based research into quality

  23. Possible research areas • Which clinical topics? • What best approaches? • Patient acceptance? • Clinician Acceptance? • Better outcomes?

  24. SDM website resources • http://ipdas.ohri.ca/ • http://decisionaid.ohri.ca/ • http://www.cbdsm.org/intro • http://www.vaoutcomes.org/index.html

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