Shared Decision Making....

[physasst]

So, I have 3 grants that I am in the middle of writing, or getting ready to write...in addition to 6 papers in various stages of writing, and 2 EM/Cardiac research projects that I am finishing data analysis on before writing.

 

One of these 3 grants will be specifically aimed at studying shared decision making in PAs and NPs in my state.

 

I am therefore, kind of curious as to your opinion on SDM. I'd be interested in your answers to a couple of questions (this might help inform some of the study questions)..

 

1. Do you use shared decision making principles in your practice? If yes, why? If not, why?

 

2. Do you understand the concepts of shared decision making, and have you ever had any formal training in it?

 

3. Do you believe that shared decision making principles can lower costs and improve quality? If yes, why? If not, why?

 

Thanks, just interested in your thoughts. I'm looking for general trends, which might help inform the formal study questions.

 

Mike

[ventana]

So, I have 3 grants that I am in the middle of writing, or getting ready to write...in addition to 6 papers in various stages of writing, and 2 EM/Cardiac research projects that I am finishing data analysis on before writing.

 

One of these 3 grants will be specifically aimed at studying shared decision making in PAs and NPs in my state.

 

I am therefore, kind of curious as to your opinion on SDM. I'd be interested in your answers to a couple of questions (this might help inform some of the study questions)..

 

1. Do you use shared decision making principles in your practice? If yes, why? If not, why?

 

2. Do you understand the concepts of shared decision making, and have you ever had any formal training in it?

 

3. Do you believe that shared decision making principles can lower costs and improve quality? If yes, why? If not, why?

 

Thanks, just interested in your thoughts. I'm looking for general trends, which might help inform the formal study questions.

 

Mike

 

 

please expound on what you consider shared decision making

[physasst]

please expound on what you consider shared decision making

 

Charles...http://www.sciencedirect.com/science/article/pii/S0277953696002213

 

We suggest as key characteristics of shared decision-making (1) that at least two participants—physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

 

One recent study that I was involved with was done regarding chest pain patients. Instead of admitting every patient for serial enzymes and a functional study, we developed a decision aid and a clinical decision rule. We were able to tell a patient what their risk was of progressing to an event within the next 48 hours. We then asked them to help us make the decision about admitting or sending home to follow up with cardiology. It was amazing. Many patients, once they understood the risks and benefits, and were ASKED about their preference, chose to go home to follow up. Saving money and resources.

 

Basically not just informing a patient about a procedure or treatment, but allowing them to choose between a list of options. "Sharing" the decision with the patient.

[ventana]

1. Do you use shared decision making principles in your practice? If yes, why? If not, why?

 

 

Yes i do - commonly on the example you gave - working in primary care and urgent care I do get the patient who complains of chest or abd pain that I could easily just punt to the ER and move on. however I try very hard to sit down and explain what the choices are and educate the patient enough so that we can make the decision together - however if there is a true medical recomendation I always state that "the official medical recomendation is to go to the ER right now" and this is what I will document in the chart. I have many times had patients clearly state that they do not believe that they are in danger and they "just wanted to get checked out" Not a one has comeback to haunt me (that I am aware of) I am very careful to create good notes and to never sugar coat the truth to avoid an ER. In fact I tend to write pretty detailed notes in these cases so someone else stepping in will clearly see the decision making process and education.

 

 

 

2. Do you understand the concepts of shared decision making, and have you ever had any formal training in it?

 

 

only what you have described int he above example - no formal training, just slowing down and educating patients and trying to get them to take some ownership over their own health and not be a passive observer

 

 

 

 

3. Do you believe that shared decision making principles can lower costs and improve quality? If yes, why? If not, why?

 

from my own practice I think it is helpful, but it takes time - I could probably see 2 more patients in the time I take to accomplish this so unsure how easily it will be to implement on a big scale

[True Anomaly]

1. Yes, when I'm able to, I try to bring the patient in on the decision-making. Chest pain is a bit more of a minefield for me though- depending on which hospital I'm at on a particular day, the patient population may or may not have good follow-up, so we end up admitting/observing most chest pains for enzymes/provocative testing at once facility more than another. However, when it comes to a myriad of other minor decisions- antibiotics for otitis media in an older child who is nontoxic, crutches/ace wrap vs splinting for a minor sprained ankle, etc- I find myself coming to a consensus with the patient on a treatment decision rather than "This is the way it's gonna be". It even helps with trying to understand just why the patient is there for care, and not just assuming they want one thing only. Just yesterday, I had a patient with prior lumbar back surgery on percocets for chronic pain who slipped and fell yesterday- an eye-roller for most people. In talking with him though, all he wanted was to make sure he didn't break any bones- he didn't want any pain medication. It made the encounter go so much more smoothly. Put simply, it works.

 

2. I have no formalized training in it- it seems as though it's a relatively new concept, borne out of good communication with the patient in front of you, which should already be a part of quality health care.

 

3. I believe it can certainly lower costs, but not sure about "improving quality", as that's a broad-based term that can mean many different things. If by improving quality you're improving patient satisfaction, then I firmly believe it improves quality. Improving quality could also mean you are using more evidence-based practice; ie, explaining to the patient that you don't have a clinically significant neck fx because you meet the NEXUS criteria; you don't have a significant fx ankle because you pass the Ottawa Ankle Rules; you don't have strep throat because you meet none of the Centour criteria, etc. The "lowered costs" part of the equation seems to go hand-in-hand with this SDM concept- less money on medications, less money spent on hospitalizations that can probably be avoided, less diagnostic testing use.