 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Michael Kirshner, DDS, MPH, Kaiser Permanente Center for Health Research, Kaiser Permanente Center for Health Research, 3800 North Interstate Ave, Portland, OR 97227 and Laurie A Doyle, MPH, Kaiser Permanente Care Management Institute, Kaiser Permanente, One Kaiser Plaza - 16 L, Oakland, CA 94705, 510-271-6898, laurie.doyle@kp.org.
Shared decision-making (SDM) can be defined as deliberate and collaborative communications between the patient, family and clinician to provide balanced and comprehensible information on treatment alternatives, elicit and weigh patient preferences and values, and arrive at a joint health decision. Kaiser Permanente has launched an initiative to further disseminate effective SDM approaches. An analysis of current SDM literature, including the latest systematic reviews, reveals: 1. There are two categories of SDM programs: a) those aiming to motivate the patient to undertake what is known to be effective care and b) those aiming to identify and match patient values and preferences when there is scientific uncertainty on effective treatment; 2. Preference for SDM is higher for major health decisions, e.g. those involving surgery; 3. Patient decision aids used to support SDM improve cognitive and affective aspects of decision making. In some cases, they are associated with increased preference for less intensive treatment and lower costs; 4. While no one patient decision aid has been shown to be superior, there are key elements that correlate with positive outcomes and overall effectiveness; 5. Implementation of SDM in a real world setting can be challenging. Based on this evidence review, the authors offer guidelines to promote effective SDM programs in medical settings, including: focus development of SDM programs on specific health decisions where interest is highest and variation in care greatest; ensure key elements are incorporated into the decision aid, provide a simple decision making worksheet to guide both clinicians and patients, and others.
Learning Objectives:
Keywords: Decision-Making, Collaboration
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: The Ottawa Decision Support Guide, University of Ottawa and Ottawa Health Research Institute
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.