PSA screening: Is Having a PSA Test Right for You?īariatric Weight Loss Surgery: Weight Loss Surgery: Is it Right for You?Ħ6% viewed a portion of the decision aid and 27% answered three knowledge questions correctly
#MAKE INFORMED DECISIONS PORTABLE#
In clinic by care assistant b who is charged with delivering decision aids to patientsĬare assistant facilitated in clinic, using a portable DVD player, administering a knowledge survey, entered the viewing status and knowledge score into the electronic medical record to alert the physician. Maximize number of patients getting decision aidĬRC screening: Colon Cancer Screening: Deciding What’s Right for YouĬompared to usual care, 11% increase in CRC screening in attending physician patients with 8% of patients reporting viewing the decision aid no increase in CRC screening in resident physician patients
Achieving high levels of decision aid use requires: (1) that the practice be able to identify which patients are eligible for specific decision aids and then communicate this information to the providers and/or the patient (2) that the practice determine how best to deliver decision aids to the eligible patients, including determining when and where the decision aid should be viewed and who within the practice should be responsible for making sure the patient receives the decision aid and (3) that the practice ensure that the patient is able to have any remaining questions answered after viewing. We have identified several key elements to the effective delivery of decision aids. Implementation of decision aids in primary care is known to be difficult. To promote decision aids, we have undertaken efforts to redesign our practice systems and develop a culture change focused on providing decision support to our patients. The cornerstone of our initiative is the use of video decision aids, either in a DVD format or by streaming video over the internet. Patient Decision Quality Initiative at UNC Decision aids also increased the likelihood that individuals prefer an active to a passive role in clinical decision-making. 9, 10 Patients who view decision aids have increased knowledge and more realistic expectations about their treatment options. Effectiveness of decision aids was demonstrated in a recent Cochrane Collaboration systematic review of 55 randomized trials.
One of the advantages of using patient decision aids is that robust evidence supports their effectiveness. 9 Decision aids delivered in a video format are particularly useful, as they may help patients overcome health literacy barriers. mastectomy for breast cancer) to treatment of chronic conditions (therapy for benign prostatic hyperplasia). prostate cancer screening) to single-event treatment decisions (breast conserving therapy vs. 3, 4 Decision aids have been developed in paper-based, video, and computer formats and have addressed a range of health questions from preventive services (e.g.
In this sense, they are designed to meet Braddock’s criteria for informed decision-making. Decision aids assist with identifying the nature of the decision, inform patients about the relevant options, present information regarding the consequences of the different options (benefits, harms, costs), help the patient assess his or her values with respect to the decision in question, and prepare the patient to use this information to reach a decision along with his or her provider. The provider can then focus the time in the patient encounter on individualizing the decision-making process to the particular patient based on their personal values, which is the second critical step for informed decision-making.ĭecision Aids to Promote Informed Decision-Makingĭecision aids are promising tools that serve to provide information to patients and prepare them for their visit with the provider. Relying on a systematic approach to provide information makes sense because it assures the fidelity and takes the burden of providing information away from the provider. However, the fidelity (This term is not clear, fidelity with what?) with which providers supply information for specific medical decisions is variable and may not be the most efficient use of their time. 8 The rationale for this approach is that providing information to patients is the first critical step towards achieving informed decision-making. Similar to the chronic care model, practices could implement system changes that focus on decision support to bolster informed decision-making. Practice-Based Approach to Promote Informed Decision-MakingĪnother approach would be to focus on helping individual practices implement decision support.
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