ConsumerPurchaser Disclosure Project Shared DecisionMaking Discussion Forum

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Consumer-Purchaser Disclosure ProjectShared
Decision-Making Discussion Forum

• Lyn Paget
• July 1, 2009

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Overview of Presentation

• Brief history of Foundation
• Patient Decision Aids Shared Decision Making
• Research/Demonstrations
• Policy/Legislation

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Intellectual Roots

• Variation Research
• Decision-making science quality
• Social science
• Clinical expertise

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Concept for the Foundation

• Decrease unwarranted variation increase
  decision quality by changing the standard of care
  to one where patients are informed involved in
  medical decision making.

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Simply put

• Assure that people understand their choices and
  have the information they need to make sound
  medical decisions.

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Foundation

• Patient decision aids
• Research
• Practical challenges of engaging patients
• Theoretical basis of decision support medical
  decision making
• Decision quality
• Clinical practice demonstrations
• Advance policy

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Develop Patient Decision Aids
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Decision Aid Development

• Literature review and synthesis
• Patient and provider focus groups
• Organize content (framing, key clinical insights,
  data)
• Recruit patients and providers for interviews
• Collaborate with Health Dialog to develop a
  rough cut for evaluation

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Evaluation

• What
• Clinical accuracy, balance, acceptability,
  knowledge
• How
• Patients (20 - 30) who have condition or have
  made decision
• Medical Editor and Clinical Advisors
• Foundation and Health Dialog staff
• Reviewers (not involved previously)
• Final program reflects evaluation input.

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Review and Updates

• Every 6 months
• Medical Editor reviews DVD and booklet
• Clinical accuracy
• Every 2 years
• Medical Editor, Clinical Advisors, Reviewers
• Focus groups, 20 to 30 patients
• Clinical accuracy relevance/acceptability
  knowledge (patients)
• Programs revised as needed.

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Distribution

• Health Dialog (health coaching model)
• Research sites (provider models)

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Do they work?

• Cochrane Collaborative

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When patients are informed

• They consistently choose less treatment testing
• Bypass surgery
• Hormone replacement therapy
• PSA testing
• Breast cancer treatment
• Prostate surgery

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When patients see DAs

• 70 of patients set more realistic expectations
• Less decisional conflict exists
• Better match between choices and values
• 50 move from undecided to decided
• Patients are 40 less passive in decision making

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The role of decision aids in shared
decision-making

• Clinical Demonstrations

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Demonstration Site Goals

• Learn how DAs SDM can be effectively deployed
  in clinical settings
• Promote system changes which encourage broad
  uptake of SDM
• Expand knowledge to facilitate integration of DAs
  SDM

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Demonstration Sites
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Implementation Tactics

• Provider engagement
• Patient identification
• Program distribution
• Timing
• Channels
• Program viewing
• Closing the loop

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What are we learning?
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Value Enhanced

• Provider endorsement
• Supportive infrastructure
• Measures of decision quality
• Integration in clinical pathways

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How do we reach the tipping point?
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Policy Reform to Advance a New Standard
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Legislation

• States Explore Shared Decision Making Bridget M.
  Kuehn
• JAMA. 2009301(24)2539-2541.

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Reforming States Group

• Shared Decision-Making Seminars
• 4 Seminars for 160 participants
• 46 states represented

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(No Transcript)
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Common Elements

• Platform for pilot projects
• Clear economic incentives
• Preference-sensitive conditions
• Certification/quality standards
• Professional training
• Evaluation

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Quality Standards

• Certification
• Decision support materials
• Shared decision-making process
• IPDAS work
• International Patient Decision Aids Standards
• 14 countries represented

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Thank You!

• lpaget_at_fimdm.org
• 617-367-2000 x243