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August 21st, 2017

Shared decision making should encourage conversations, researchers contend

By Adam Harringa

Shared decision making involves educating patients so they can work with clinicians to make decisions about their care. Mayo Clinic researchers advocate for tools that promote a conversation during the visit (called conversation aids), and not simply provide information to the patients beforehand for them to make a decision themselves (referred to as patient decision aids).

To improve quality and reduce health care spending at a population level, state and federal agencies have begun requiring shared decision making tools for certain procedures and tests. With legal and financial incentives, the Centers for Medicare and Medicaid Services and others aim to move the industry toward value-based care.

But do shared decision making tools, which involve educating patients so they can work with clinicians to make decisions about their care, improve care? Mayo Clinic is helping answer that question.

Researchers in the Mayo Clinic Knowledge and Evaluation Research Unit published an editorial in JAMA on Aug. 15 on shared decision making. The researchers advocate for tools that promote a conversation during the visit (called conversation aids), and not simply provide information to the patients beforehand for them to make a decision themselves (referred to as patient decision aids). The researchers contend that patient decision aids can burden patients with having to decline their clinicians’ recommendations, but conversation aids directly encourage patient-clinician dialogue and a joint decision.

“While some organizations simply distribute decision aids to patients and consider the job done, we believe that patients are best served by an unhurried consultation,” says senior author Juan Brito Campana, M.B.B.S., medical director of the Mayo Clinic Shared Decision Making National Resource Center.

The Mayo researchers cite research, also published Aug. 15 in JAMA, which looked at 105 clinical trials involving more than 31,000 patients. That research found that shared decision making tools are associated with improved patient knowledge of options and outcomes, and do not consistently reduce the use of invasive or expensive treatments. More importantly, they couldn’t find strong evidence that these tools promote conversations between patients and clinicians. In fact, only five of the clinical trials – all conducted by the Mayo Clinic Shared Decision Making National Resource Center – sought to promote these conversations and observed what happened during these visits.

“Future research must discover new ways to promote meaningful conversations between patients and clinicians,” says co-author Marleen Kunneman, Ph.D., of the Knowledge and Evaluation Research Unit.

The Mayo Clinic researchers argue that conversation aids could achieve the stated goal – patients and clinicians working together to decide which option best fits the patient – while imposing the smallest footprint as possible on patients’ lives.

“Clinicians want to truly appreciate what is going on with their patients and how best to move forward,” Dr. Brito Campana says. “Shared decision making is one way to achieve this goal.”

The Mayo Clinic Shared Decision Making National Resource Center advises clinicians and researchers in the design, evaluation and implementation of shared decision making tools, helping Mayo lead in this field. The center has developed conversation aids for chest pain, diabetes medication, and osteoporosis, among many others.

Dr. Brito Campana is a Kern Health Care Delivery Scholars Program alumnus within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Tags: conversation aid, Findings, Juan Brito Campana MBBS, Kern Center for the Science of Health Care Delivery, Marleen Kunneman PhD, Mayo Clinic Knowledge and Evaluation Research Unit, Mayo Clinic Shared Decision Making National Resource Center, patient decision aid, shared decision making, Victor Montori MD

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