Lessons learned implementing patient decision support in routine - - PowerPoint PPT Presentation

Lessons learned implementing patient decision support in routine care

Dominick L. Frosch, PhD

How do we engage patients in making choices about their care?

Prescription Strength Information for Better Decisions Better Decisions --Together Partners in Medical Decision Making

Lin, Halley, Rendle, Tietbohl, May, Trujillo & Frosch (2013). Health Affairs.

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But aggregate outcomes don’t tell the whole story

50 100 150 200 250 300 350 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 # of Decision Aids Distributed % of Eligible Patients Reached Project Month

Overall Decision Aid Distribution and Proportion of Patients Reached for CRC Screening & Back Pain

% Reached for Combined CRC & BP Distribution Totals for All Topics

Note: The red line corresponds to the y-axis at the left, and depicts the percentage of potentially eligible patients who received a decision aid for either colon cancer screening or back pain across all five clinics. The blue line corresponds

Few eligible patients received decision support

One patient’s story

• Patient saw physician for annual physical

exam.

– MD provided decision support on colon cancer

• screening. Patient reviewed it home.
• Patient contacted physician via online

patient portal.

– Requested stool test option. – Physician refused: “We only believe in 2 options: colonoscopy or flexible sigmoidoscopy”.

• Patient confused, unsure what to do and

indicated she was unwilling to assert her preferences and disagreement.

I prefer this

• ption

Lin, Trujillo & Frosch, 2012; Archives of Internal Medicine

Why was this so hard?

• Physicians prefer to be in control of

decisions

• Physicians claim they don’t have enough

time to provide DESIs to patients

• Paradoxically high utilizers think they save

time

• But it has to be made as easy as possible
• And engaging patients has to be measured,

monitored and rewarded

Thinking about the appointment you have just had ...

• 1. How much effort was made to help you understand your health issues?

1 2 3 4 5 6 7 8 9 No effort Every effort at all was made

• 2. How much effort was made to listen to the things that matter most to you

about your health issues?

1 2 3 4 5 6 7 8 9 No effort Every effort at all was made

• 3. How much effort was made to include what matters most to you in choosing

what to do next?

1 2 3 4 5 6 7 8 9 No effort Every effort at all was made

Elwyn et al. Patient Education & Counseling. 2013 Oct;93(1):102-7. Barr et al. J Med Internet Res. 2014 Jan 3;16(1):e2.