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July 20th, 2017

Shared Decision Making: from Buenos Aires to Lyon

By Victor M. Montori

Submitted by Paula Riganti

We were very thrilled to participate at the ISDM conference in Lyon. We were honored to had been invited to contribute in the Special ISDM ZEFQ Issue regarding the state of implementation of SDM in different countries. The development of SDM in our country is challenging, as Mariela Barani, our lead researcher, has discussed with other colleagues at the Sunday Workshop on national strategies for implementing SDM.

We are currently exploring the perceptions from our health professionals and patients regarding SDM in our setting. Our activities in this conference included the presentation of our latest research on trans-cultural adaptation of SDM measuring, a co-chairing of one of the oral sessions and three poster presentations about women’s perceptions on breast cancer screening, a validation of a search filter for studies on patient’s values and preferences, and health professionals and patients perceptions regarding participation in SDM in a low health literacy community.  It was a great opportunity to learn from other experiences and become enlightened with a wide variety of research studies.

We highlight the need for short validated tools in non-English speaking languages to aid the evaluation and improvement of clinical practice. We think that this conference will help us improve our initiative to locally empower patient-centered care research and implementation.

We also reflected with Victor Montori about SDM and financial incentives. It is on vogue worldwide today the use of financial incentives to boost SDM activities. But in practice, our perception is that those incentives only stimulate the simply registration of the use of a decision aid but does not guarantee that a SDM conversation has taken place between the patient and his caregiver. Victor agreed with us and also added other arguments for not incentivizing with money SDM: 1) SDM is good practice and that is enough to justify its introduction in clinical practice; 2) When you start paying for something, money will not last forever and after some time you will be in need of changing the financial incentive to other indicator or stop paying for it. And caregivers that have been payed for doing SDM until that moment will ask for money to continue doing it; 3) Once you start incentivize a SDM indicator, it will go up because doctors know that you are measuring it and they are being evaluated trough that indicator. After some time, when doctors forget about it, it will decline. This is called Hawthorne effect, also referred to as the observer effect, and is a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed.

So we came to the conclusion that to incentivize SDM, we have to work on changing culture and make SDM a part of clinical practice.

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