Insights from a conference on implementing comparative effectiveness research through shared decision-making

Abstract

For decades, investigators have conducted innovative research on shared decision-making (SDM), helping patients and clinicians to discuss health decisions and balance evidence with patients' preferences for possible outcomes of options. In addition, investigators have developed and used rigorous methods for conducting comparative effectiveness research (CER), comparing the benefits and risks of different interventions in real-world settings with outcomes that matter to patients and other stakeholders. However, incorporating CER findings into clinical practice presents numerous challenges. In March 2012, we organized a conference at Washington University in St Louis (MO, USA) aimed at developing a network of researchers to collaborate in developing, conducting and disseminating research about the implementation of CER through SDM. Meeting attendees discussed conceptual similarities and differences between CER and SDM, challenges in implementing CER and SDM in practice, specific challenges when engaging SDM with unique populations and examples of ways to overcome these challenges. CER and SDM are related processes that emphasize examining the best clinical evidence and how it applies to real patients in real practice settings. SDM can provide one opportunity for clinicians to discuss CER findings with patients and engage in a dialog about how to manage uncertainty about evidence in order to make decisions on an individual patient level. This meeting highlighted key challenges and suggested avenues to pursue such that CER and SDM can be implemented into routine clinical practice.

Shared decision‐making and patient control in radiation oncology: Implications for patient satisfaction

“…SDM takes into account physician expertise as well as patient beliefs and values to jointly develop a medically acceptable treatment plan. With this evolving patient‐provider relationship comes a significant need for the medical community to develop tools and training methods for both physicians and patients to adapt to this method of decision‐making …”

“…With this evolving patientprovider relationship comes a significant need for the medical community to develop tools and training methods for both physicians and patients to adapt to this method of decision-making. 19,20 In the current study, comprising a group of radiation oncology patients with diverse demographic and clinical characteristics, only approximately one-third of patients experienced SDM or perceived a sense of control in their radiation treatments. These numbers are consistent with prior studies examining SDM in the oncology setting.…”

Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making

“…In particular, SDM has been recommended as a way to encourage patient-physician conversations regarding uncertainty in treatment options, making it particularly relevant to comparative effectiveness research. (Politi et al 2013) For research questions aimed at determining treatments when there is limited high-quality, clinical evidence, SDM can support collaborative physician-patient decision-making that addresses uncertainty and bridges the power gap between patient and physician knowledge while promoting transparency and trust. (Braddock 2013)…”

Shared decision-making and comparative effectiveness research for patients with chronic conditions: an urgent synergy for better health

“…Several recent conferences [90] and grants (e.g., Agency for Healthcare Research and Quality’s Innovative Adaptation and Dissemination of CER), have highlighted the potential synergy between SDM and CER. Most recently, in June of 2013, SDM stakeholders from around the globe gathered in Lima (Peru) for the 7th International Shared Decision-Making Conference [103].…”