Primum Non Nocere: is shared decision-making the answer? Clinicians' Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review. The risk of death by age, sex, and smoking status in the United States: putting health risks in context. What’s More Dangerous, Your Aspirin Or Your Car? Thinking Rationally About Drug Risks (And Benefits) Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention. Project Information Principal Investigator Hazel Tapp, PhD, BSc Project End Date Click Here!
Includes the Research Project Period and may be subject to modification to allow other research-related activities such as peer review. Organization Carolinas Medical Center Project Start Date May 2013 Funding Announcement. Picture this: a new way of seeing risk. Interventions for improving the adoption of shared decision making by healthcare professionals. MMS: Error. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial.
Erik P Hess, associate professor1 2 3, Judd E Hollander, professor4, Jason T Schaffer, assistant professor5, Jeffrey A Kline, professor5, Carlos A Torres6, Deborah B Diercks, professor7, Russell Jones, assistant professor8, Kelly P Owen, assistant professor8, Zachary F Meisel, assistant professor9, Michel Demers, patient adviser10, Annie Leblanc, research collaborator and caregiver adviser2 11, Nilay D Shah, associate professor11, Jonathan Inselman, statistical programmer analyst3, Jeph Herrin, biostatistician13, Ana Castaneda-Guarderas, resident1 2 14, Victor M Montori, professor2 15Author affiliationsCorrespondence to: E P Hess email@example.comAccepted 3 November 2016 Abstract Objective To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome.
Design Multicenter pragmatic parallel randomized controlled trial. Shared Decision Making: A Model for Clinical Practice. To accomplish SDM, we propose a three-step model for clinical practice (see Fig. 1).
We want to emphasize that this is a simplified model that illustrates the process of moving from initial to informed preferences. We acknowledge that this process also has psychological, social and emotional factors that will influence this deliberation space and that will need to be managed by an effective clinician-patient dialogue, seeking what Epstein has termed a ‘shared mind’.33 However, accepting these requirements, we aim for parsimony. We describe three key steps of SDM for clinical practice, namely: choice talk, option talk and decision talk, where the clinician supports deliberation throughout the process (Fig. 1 and Boxes 1, 2 and 3).
Choice talk refers to the step of making sure that patients know that reasonable options are available. Measurement challenges in shared decision making: putting the ‘patient’ in patient-reported measures - Barr - 2015 - Health Expectations. Helping Patients Decide: Ten Steps to Better Risk Communication. Every day, oncologists and their patients are confronted with difficult decisions about what type of treatment patients should receive. For example, breast cancer patients must first decide on what type of surgery to undergo and then whether to undergo adjuvant therapies such as chemotherapy and hormonal therapy. Early-stage prostate cancer patients must decide between active surveillance, radical prostatectomy, and radiation (external beam or brachytherapy). Those diagnosed with thyroid cancer must decide whether to have radioactive iodine therapy. These types of decisions are “preference sensitive,” meaning that the “right” treatment depends on a given patient’s preferences—on the relative weight the patient gives to the risks and benefits of the treatment (1,2).
Effective reassurance of patients. Rammya Mathew and James McGowan: The role of shared decision making in a value based NHS. Last month a controversial proposal was made by Vale of York clinical commissioning group (CCG) to deny obese patients access to elective surgery for up to a year.
The headlines were alarming and the approach felt wrong. The CCG defended its position by saying that it was “the best way of achieving maximum value from the limited resource available.” The suggestion is now under review in the wake of the outcry it caused, but is this a sign of the kind of care rationing we will increasingly start to see? As the Carter review of productivity in hospitals explained at length, the NHS must make better use of scarce resources. There is a strong ethical rationale for doing so; money spent on the care of one patient is money unavailable for the care of another. Physician Understanding and Ability to Communicate Harms and Benefits of Common Medical Treatments. This survey study describes academic internal medicine physicians' understanding of benefits and harms of common medical interventions, their use of statistical terms in patient communication, and their awareness of high-value health care campaigns.
Effective patient care requires not only a working knowledge of recommended tests and therapies but also an understanding of the frequency of harms and benefits for each. Twelve myths about shared decision making - Patient Education and Counseling. Notwithstanding these developments, arguments against the scaling up of shared decision making across the healthcare continuum abound.
Given its high profile, shared decision making has gained supporters as well as critics. In this paper, we discuss some of the most commonly encountered myths about shared decision making and review the evidence most relevant to these myths. Talking to the Doctor About Treatment Harms. Whether preparing to undergo sensitive surgery or facing the prospect of spending a night in the hospital, patients often lack a critical piece of information to make an informed medical decision.
“Risks are not being adequately discussed by physicians with their patients,” says David Magnus, director of the Stanford Center of Biomedical Ethics in Stanford, California. Research shows doctors frequently talk little or not at all about how treatment could possibly harm patients or even lead to their death, whether they’re being admitted to the hospital for chest pain; undergoing a procedure to get an implantable device used to prevent sudden death from certain heart conditions, such as ventricular tachycardia; having prostate removal surgery to treat cancer; or discussing general care with a primary care physician.
“The moment of communication we were studying, was a moment where the decision to admit a patient to the hospital had just been made,” says lead study author Dr. Margaret McCartney: The conflict of choice. Shared decision making is the pivot on which modern medical ethics rest.
Doctor appraises patient of the choices available. Doctor supplies evidence and lays out the pros and cons. Patient has the intervention of choice. We are all happy. Except we’re not. Earlier this year Victoria Coren Mitchell, the professional poker player, wrote that her GP would no longer prescribe the combined oral contraceptive for her at age 35 “because I smoked and thus sat badly on the contraindications graph for heart attacks. Should she have been allowed to make that choice? A Comparative Effectiveness Trial of Alternate Formats for Presenting Benefits and Harms Information for Low-Value Screening Services: A Randomized Clinical Trial. A Comparative Effectiveness Trial of Alternate Formats for Presenting Benefits and Harms Information for Low-Value Screening Services: A Randomized Clinical Trial.
Corresponding Author: Stacey L.
Sheridan, MD, MPH, University of North Carolina at Chapel Hill, Division of General Medicine and Epidemiology, 5039 Old Clinic Building, CB 7110, Chapel Hill, NC 27599 (Stacey_sheridan@med.unc.edu). Accepted for Publication: October 29, 2015. Published Online: December 28, 2015. doi:10.1001/jamainternmed.2015.7339. Author Contributions: Dr Sheridan and Ms Sutkowi-Hemstreet had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Patient Decision Aids for Discouraging Low-Value Health Care Procedures: Null Findings and Lessons Learned. Reducing the use of low-value health services is a complex issue, with significant clinical and health policy implications.
The study by Sheridan and colleagues2 provides a useful vantage point for informing future efforts. Certainly, hindsight is 20/20. Doctors and patients making decisions together reduces antibiotic prescribing: an important part of the fight against antibiotic resistance. A new Cochrane Review published today shows that when doctors and patients are encouraged to discuss the need for prescribing antibiotics for acute respiratory infections jointly, fewer are prescribed. This may be useful in the fight against antibiotic resistance. The Bond-led research shows shared decision making between clinicians and patients is an important part of patient-centred care.
The ideal process combines the best available evidence about the benefits and harms of an intervention with the patient’s values and preferences, as part of a discussion with their general practitioner (GP) or health professional. As a result, the health professional and patient jointly make the decision about what to do next. Acute respiratory infections such as an acute cough, middle ear infection, or sore throat are among the most common reasons to see a doctor, especially during the winter.
Patients’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review. Using Option Grids: steps toward shared decision-making for neonatal circumcision - Patient Education and Counseling. Fig. 1 Observer OPTION5 Scores: Means and differences in means pre- and post-intervention by group and clinician. Highlights •Determining parent preferences is key to good decision making for neonatal circumcision.
•There is evidence to show that clinicians vary in the extent to which they elicit and integrate parental preferences when circumcision is considered. •Encounter tools such as Option Grids may help facilitate shared decision making. Abstract Objectives. Shared decision making: what do clinicians need to know and why should they bother? Lucille is a 2.5-year-old who has had a cold for 3 days. Last night, it became worse — Lucille was restless and had a fever. Her mother was up with her for much of the night, and she settled eventually with paracetamol. The mother and Lucille come to see you today and both look exhausted. Getting to “No” Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial.
Patients, Providers, And Systems Need To Acquire A Specific Set Of Competencies To Achieve Truly Patient-Centered Care. + Author Affiliations ↵*Corresponding author Studies show that patients want to be more involved in their own health care. The Value of Sharing Treatment Decision Making With Patients: Expecting Too Much? Authoritarian Physicians And Patients' Fear Of Being Labeled 'Difficult' Among Key Obstacles To Shared Decision Making. Decision aids for people facing health treatment or screening decisions - The Cochrane Library - Stacey. Background Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. Objectives To assess the effects of decision aids for people facing treatment or screening decisions.
Search methods For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Selection criteria. Prenatal Genetic Testing:, Effect of Enhanced Information, Values Clarification, and Removal of Financial Barriers on Use of: A Randomized Clinical Trial. Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease. Editorials: Introducing Medicine by the Numbers: A Collaboration of The NNT Group and AFP.
Medicine by the Numbers: Ondansetron for Gastroenteritis in Children and Adolescents. Medicine by the Numbers. Good Stewardship - Provider Version - 640x360_h264_1.mp4. The Doctor Game: Do you really need a CT scan? How many people will die from excessive radiation exposure? Today, more patients get CT scans for a variety of problems. So how can patients decrease the risk of excessive exposure? Consumer Reports on Health says the number of CT scans in the U.S. in 1980 was under three million.
Now in 2015 it’s 80 million. Experts claim that about one-third of the scans have little medical value. In the past it’s been said that the radiation threat is greatest in children. Patients Clueless About Treatment Risks; Docs Little Help. Patients are dangerously clueless about the true value of many common medical interventions and physicians aren't doing enough to correct their misunderstandings.