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November 16th, 2012

ISDM 2013: Call for Abstracts extended


The deadline for abstract submissions for ISDM 2013 has been extended until January 11, 2013. Abstracts are to submitted electronically at the conference website.

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October 2nd, 2012

What is shared decision making?


Mayo Clinic's Dr. Montori recently spoke with IHI Open School regarding shared decision making.  The discussion was captured in two brief videos that can be viewed here. In the first video Dr. Montori discusses the impact of shared decision making on healthcare, and decision aid tools are described in the second video.

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September 22nd, 2012

Peru ISDM 2013: Call for Abstracts


We are happy to announce we have made our call for abstracts and reviewers for ISDM 2013, which will be held in Lima, Peru June 16-19, 2013. Details can be found in our ISDM 2013 call for abstracts and in our ISDM2013 call for reviewers.

ISDM conferences are a unique venue for worldwide sharing of knowledge and experiences about shared decision making. This year’s theme seeks to highlight that shared decision making is a key component of something more global, i.e., patient‐centered care, and that its application is only relevant as part of a commitment to care for and about patients. We invite investigators and concerned partners in healthcare delivery research and practice to struggle with the issues that arise as shared decision making globalizes in scope (as a component of patient‐centered care) and spread (as a component of healthcare everywhere for everyone).

The abstract submission process for ISDM 2013 is fully electronic and the deadline for submissions is Friday, November 30, 2012. Abstracts for poster presentations, oral presentations, symposia, workshops, exhibits, and special interest group meetings that pertain to shared decision making (SDM) are welcome.

Please follow the link for registration and detailed abstracts submission process: https://www.conference-service.com/ISDM-2013/welcome.cgi

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August 10th, 2012

WIHI Talkshow: Minimally Disruptive Medicine


Drs. Montori and Shah from Mayo Clinic were featured on the August 9, 2012 WIHI (Institute for Healthcare Improvement) Talkshow in a discussion about minimally disruptive medicine. The 60-minute broadcast audio, with host Madge Kaplan, can be heard here.  Some chat responses to the opening question: "If you could change one thing in your interactions and discussion with patients with chronic conditions, what would that be?" included:

  • More of a partnership
  • Time to listen and be listened to
  • Base treatment on the patient's goals, not our goals for them
  • A holistic approach to care
  • Clarify with the patient what his or her long-term goals are

These comments highlight the talkshow's topic of minimally disruptive medicine. As Dr. Montori stated: "The goal needs to be shifting and sharing responsibility for chronic disease with patients and families — not shifting the burden."

On what we believe to be the first interactive decision aid exercise on webinar, the listeners were offered the Statin Choice decision aid with a 20% risk of having a heart attack in the next 10 years. Over 2/3 of responders declined to take statins, although the guidelines would strongly recommend such people take statins!

Minimally disruptive medicine and shared decision making efforts at the Mayo Clinic were also mentioned in IHI's Pursuing the Triple Aim (Maureen Bisognano & Charles Kenney, Jossey-Bass, 2012).

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July 14th, 2012

New treatment guidelines consider patient characteristics


A recent article in the Wall Street Journal, Health & Wellness magazine, New Strategies for Treating Diabetes, discusses new guidelines for treatment of Type 2 diabetes which were published in June. The new guidelines suggest patient preferences and characteristics such as age and general health be considered by doctors when treating patients with Type 2 diabetes. The Shared Decision Making National Resource Center has promoted this consideration of patient preferences and individualized treatment plans. Patient decision aids, which are developed through the Center, give voice to the patient, as Dr. Montori points out as important in the article.

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July 6th, 2012

KER Unit presents at Academy Health Annual Research Meeting


Members of the Knowledge & Evaluation Research Unit were honored to present at the 2012 Academy Health Annual Research Meeting, which was held June 24-26 in Orlando, Florida. Presentations can be viewed online.  Dr. Annie LeBlanc chaired a session: Implementing Shared Decision Making in Clinical Practice (see 5:00 p.m. time on Monday, June 24), and Dr. Montori chaired: Translating Comparative Effectiveness Research in a Patient-Centered Approach (see 8:00 a.m. time on Tuesday, June 25).

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June 8th, 2012

Shared Decision Making CME


The Agency for Healthcare Research and Quality (AHRQ) presented a continuing education activity webinar in cooperation with the National Association of Free Clinics: "Practical Application of Shared and Informed Treatment Decisions Based on Comparative Effectiveness Research: Addressing the Needs of Underserved Patients with Type 2 Diabetes Mellitus." Our Diabetes Medication Choice decision aids are referenced in the 38th minute of the presentation.

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March 29th, 2012

National Academy for State Health Policy releases report “Shared Decision Making Advancing Patient-Centered Care through State and Federal Implementation”


~Written by Kasey Boehmer, Knowledge and Evaluation Research Unit

This report is based on information, recommendations, and conclusions arrived at through the organization’s convening of state and federal officials, SDM experts, and consumer, purchaser and provider representatives in October of 2011. It highlights what progress has been made at the state policy level to include SDM in healthcare delivery system improvement initiatives, state legislation, and public-private partnerships.

At the state policy level in many examples, legislators have focused on using SDM as a means to cut cost and reduce variation among conditions that demonstrate high variation across healthcare practices throughout the nation. Policy makers are keen on developing measures that accurately pinpoint SDM’s impact on cost and variation.

However, physician resistance was a key barrier to SDM implementation at the state level discussed during the October 2011 meeting. The report notes that physicians were less amenable to using SDM when the focus was placed on reduction of costs and variation. Instead clinicians were more welcoming to SDM when it was shown to improve patient care and better inform patients, and they were more interested in the length of visits that included SDM and how it would fit into clinical workflows.

The Knowledge and Evaluation Research (KER) Unit’s research to test decision aids within the clinical encounter has focused on assessing how our SDM tools impact patient satisfaction and knowledge, clinician engagement, the length added to clinical visits, and where SDM is most effective within clinical workflows. These tenets remain of key importance to clinicians, whose buy-in is critical to implement high quality SDM that will truly benefit patients. We should not lose sight of this in the policy-making arena where the focus begins with patient-centeredness but can too easily be shifted to cost savings and reduction of variation.

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March 16th, 2012

A Provocative Quote


"(Patient-centered care) PCC can too easily become a signifier onto which too vast a variety of hopes and fears are displaced.  PCC is most dangerous when used to support the idea that fixes can be local, individually focused, and legislated.  If patient-centeredness is simply grafted onto existing medical systems, it will be a marketing slogan at best, and at worst will risk precipitating detrimental reallocations of resources.

For medicine to to become truly patient centered, medical workers . . . need to be supported in changing who they believe they are and how they see themselves in relation to their patients. . . .[P]atients . . . need to be shown that medicine does believe [they are] ‘worth it’, but without that worth having to be expressed in the currency of expensive and clinically counterproductive testing. . . .

[We] would not be speaking of PCC at all – instead patient-centeredness would be self-evident – if there were not deep professional institutional reasons for being centered on concerns other than patients.”

-Frank AW. Patient-Centered Care as a Response to Medification. Wake Forest Law Review 2010: 45(5): 1453-59


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February 20th, 2012

Creating shared decision making visuals


There is quite a bit of evidence about best ways to convey risk information to help with policy or clinical decision making. Pictographs and bar graphs along with numbers and descriptions are considered best.  Some emerging research suggests that some elements will help some patients more than others (for instance people with low numeracy).

Recently, Fagerlin, Zikmund-Fisher and Ubel published their decalogue of risk communication in the Journal of the National Cancer Institute.  Their ten steps to better risk communication were:

  1.  Use plain language to make written and verbal materials more understandable.
  2. Present data using absolute risks.
  3. Present information in pictographs if you are going to include graphs.
  4. Present data using frequencies.
  5. Use an incremental risk format to highlight how treatment changes risks from preexisting baseline levels.
  6. Be aware that the order in which risks and benefits are presented can affect risk perceptions.
  7. Consider using summary tables that include all of the risks and benefits for each treatment option.
  8. Recognize that comparative risk information (eg, what the average person’s risk is) is persuasive and not just informative.
  9. Consider presenting only the information that is most critical to the patients’ decision making, even at the expense of completeness.
  10. Repeatedly draw patients’ attention to the time interval over which a risk occurs.

Online software to create pictographs can therefore be quite handy.  Some do so without resorting to giving each “person like you” an anthropomorphic shape .

Our favorite however, is one that shows the outcomes showing visual cues that are easily relatable, based on the iconic smiley face. We are impressed by Dr. Chris Cates’ Visual Rx tool, which is a free online tool that creates “smiley face plots” to depict the impact of a treatment on 100 people.

~Victor Montori, MD

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