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Decision Aids in the United States: the Patient Response

Richard Wexler, Bethany S. Gerstein, Charles Brackett, Lyle J. (LJ) Fagnan, Kathleen M. Fairfield, Dominick L. Frosch, Carmen L. Lewis, Lawrence Morrissey, Leigh H. Simmons, David Swieskowski, Yuchiao Chang, Floyd J. Fowler, Michael J. Barry

Abstract


Background:  In the United States and elsewhere, a growing chorus of voices is calling for the routine use of patient decision aids (DAs) and shared decision making (SDM) in day-to-day care.  A frequently cited barrier to this approach is the belief that many patients will not be able to understand key clinical information and/or prefer to delegate decision making to providers.  These beliefs, often held by providers, are thought to be particularly applicable to elderly and less educated patients.

Objectives: To test the perception that older and less educated patients will not value or benefit from DAs.

Research design: Self-administered questionnaires completed by patients after viewing DAs.

Subjects: 3001 patients in six primary care practice sites facing one of sixteen common medical decisions.

Measures: Amount of DA viewed, knowledge about medical tests or treatments, DA rating, and importance of receiving DAs from providers.

Results: Across age and education level, higher self-reported exposure to the DAs was associated with higher knowledge scores. Those over 65 and those who had not attended college had knowledge gains at least has high as those in other groups. There were no statistically significant differences by age or education in patient assessment of the importance of using DAs.

Conclusions: Patients in primary care settings in the U.S. learn from DAs, rate them highly, and believe that providers should make them available in ways that are mainly independent of patient age or formal education.


Keywords


Shared decision making; patient decision aids; informed choice; patient education; person centered care; health literacy

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References


Mulley AG, Trimble C, Elwyn G. Stop the silent misdiagnosis: patients' preferences matter. BMJ. 2012;345:e6572.

Lee CN, Dominik R, Levin CA, Barry MJ, Cosenza C, O'Connor AM, Mulley AG, Jr., Sepucha KR. Development of instruments to measure the quality of breast cancer treatment decisions. Health Expect. 2010;13:258-72.

Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making. Health Aff (Millwood). 2012;31:1030-8.

Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681-92.

Barry MJ. Shared decision making: informing and involving patients to do the right thing in health care. J Ambul Care Manage. 2012;35:90-8.

Fowler FJ, Jr., Levin CA, Sepucha KR. Informing and involving patients to improve the quality of medical decisions. Health Aff (Millwood). 2011;30:699-706.

O'Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood). 2004;Suppl Variation:VAR63-72.

Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JH. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;1:CD001431.

Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368:6-8.

American Medical Association. Report of the Council on Medical Services (Shared Decision-Making). CMS Report 7-A-10. 2010.

National Priorities Partnership convened by the National Quality Forum. Input to the Secretary of Health and Human Services on Priorities for the National Quality Strategy. 2011.

Center for Medicare and Medicaid Services. Pioneer Accountable Care Organization (ACO) Model Request for Application. Washington, D.C.: U.S. Department of Health and Human Services; 2012.

Center for Medicare and Medicaid Services. Medicare program: Medicare Shared Savings Program: accountable care organizations. Final Rule. Fed Regist. 2011;76:67802-990.

Barry MJ, Edgman-Levitan S. Shared decision making--pinnacle of patient-centered care. N Engl J Med. 2012;366:780-1.

Lin GA, Halley M, Rendle KA, Tietbohl C, May SG, Trujillo L, Frosch DL. An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles. Health Aff (Millwood). 2013;32:311-20.

Legare F, Ratte S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. Patient Educ Couns. 2008;73:526-35.

Elwyn G, Edwards A, Gwyn R, Grol R. Towards a feasible model for shared decision making: focus group study with general practice registrars. BMJ. 1999;319:753-6.

Schulman-Green DJ, Naik AD, Bradley EH, McCorkle R, Bogardus ST. Goal setting as a shared decision making strategy among clinicians and their older patients. Patient Educ Couns. 2006;63:145-51.

Towle A, Godolphin W, Grams G, Lamarre A. Putting informed and shared decision making into practice. Health Expect. 2006;9:321-32.

Stevenson FA. General practitioners' views on shared decision making: a qualitative analysis. Patient Educ Couns. 2003;50:291-3.

Uy V, May SG, Tietbohl C, Frosch DL. Barriers and facilitators to routine distribution of patient decision support interventions: a preliminary study in community-based primary care settings. Health Expect. 2014;17:353-64.

Tariman JD, Berry DL, Cochrane B, Doorenbos A, Schepp K. Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review. Ann Oncol. 2010;21:1145-51.

Bhavnani V, Fisher B. Patient factors in the implementation of decision aids in general practice: a qualitative study. Health Expect. 2010;13:45-54.

Lin GA, Aaronson DS, Knight SJ, Carroll PR, Dudley RA. Patient decision aids for prostate cancer treatment: a systematic review of the literature. CA Cancer J Clin. 2009;59:379-90.

Smith TJ, Dow LA, Virago EA, Khatcheressian J, Matsuyama R, Lyckholm LJ. A pilot trial of decision aids to give truthful prognostic and treatment information to chemotherapy patients with advanced cancer. J Support Oncol. 2011;9:79-86.

Sepucha KR, Levin CA, Uzogara EE, Barry MJ, O'Connor AM, Mulley AG. Developing instruments to measure the quality of decisions: early results for a set of symptom-driven decisions. Patient Educ Couns. 2008;73:504-10.

Fox S, Duggan M. Health Online 2013. Pew Research Center's Internet & American Life Project. http://www.pewinternet.org/2013/01/15/health-online-2013/. 2013.

Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns. 2006;61:319-41.




DOI: http://dx.doi.org/10.5750/ijpcm.v5i3.517

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