Shared Decision-Making Strategies for Best Care: Patient Decision Aids

Alston, Chuck; Elwyn, Glyn; Fowler, Floyd J.; Hall, Leslie Kelly; Moulton, Ben; Paget, Lyn; Shebel, Brenna Haviland; Berger, Zackary; Brownlee, Shannon; Montori, Víctor M.; Singerman, richard; Walker, J. Malcolm; Wynia, Matthew K.; Henderson, Diedtra

doi:10.31478/201409f

Cited by 65 publications

(74 citation statements)

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“…This is also true of the Agency for Healthcare Research and Quality's SHARE approach to SDM, where assessing a patient's values is step 3 of 5, occurring only after engaging the patient and helping him explore and compare treatment options [11]. While increasing research supports DAs as helpful tools for improving informed decision-making [9,12], these tools used in isolation miss the opportunity for a more holistic approach to value assessment. Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values

Armstrong

Mullins

2017

Value in Health

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Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. Additionally, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment which could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decisionmaking and provide examples of how these impact provision of healthcare. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision-making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both for overall healthcare delivery and for shared decision making, as value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision-making and facilitates a more complete value assessment at the point of care.

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Section: Introductionmentioning

confidence: 99%

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values

Armstrong

Mullins

2017

Value in Health

View full text Add to dashboard Cite

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“…31 ASCO developed a conceptual framework to present benefits, toxicities, overall costs, and out-of-pocket costs to help patients to make treatment decisions. 32 However, physicians may not be comfortable with these cost conversations.…”

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confidence: 99%

“…Such an organization communicates clearly what health plans cover and what individuals will have to pay for services. 31 However, the addressing of these concerns can be a challenge. A study of cancer center social workers and financial counselors cited a lack of financial resources, process inefficiencies, limited resources to identify at-risk individuals, and inadequate insurance coverage as barriers to addressing financial distress in patients with cancer.…”

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confidence: 99%

Relationships Among Financial Distress, Emotional Distress, and Overall Distress in Insured Patients With Cancer

Meeker

Geynisman

Egleston

et al. 2016

JOP

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Purpose: Recent studies have demonstrated increasing rates of financial toxicities and emotional distress related to cancer treatment. This study assessed and characterized the relationships among financial distress, emotional symptoms, and overall distress in patients with cancer. Methods: A cross-sectional sample of patients with cancer who visited our outpatient medical oncology and psychiatry clinics completed a pen-and-paper survey. The survey assessed demographics; cost concerns; and financial, emotional, and overall distress. Results: One hundred twenty insured patients completed the survey. Sixty-five percent reported clinically significant overall distress scores, with the same percentage reporting at least one emotional problem (worry, anxiety, depression, etc). Twenty-nine percent scored in the range of high to overwhelming financial distress. By using structural equation modeling, we found that financial distress was associated with overall distress. This association was both direct (accounting for 76% of the effect) and indirect (accounting for 24% of the effect) via mediation by emotional distress. Conclusion: This cohort of patients with cancer reported significant levels of emotional distress, financial distress, and overall distress. These factors were interrelated, with both financial and emotional distress contributing to overall distress. Interventions targeted at alleviating financial distress may help to decrease levels of overall distress.

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“…[25][26][27] Second, this trial supports previous findings that tools designed to improve patient understanding are unlikely to empower patients to create a shared decision visit with their specialist. 14,28 Finally, in the context of an increasing focus on decision aids, [29][30][31][32] this trial suggests that decision aids alone may be insufficient to promote SDM without prompts for specific clinician behaviors. Thus, this trial directs further research toward effective strategies for clinician engagement and skill development in SDM.…”

Section: Discussionmentioning

confidence: 99%

“…30 Professional societies and government agencies increasingly call for clinicians to engage their patients in SDM with minimal guidance on how best to implement this recommendation. [29][30][31] Previous efforts to promote SDM have largely focused on the patient, with most decision aids designed for patients to review on their own.…”

Section: Discussionmentioning

confidence: 99%

PCI Choice Decision Aid for Stable Coronary Artery Disease

Coylewright

Dick

Zmolek

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Although it is not clear whether this is primarily because of patient or physician preference, there is consistency in patient misperception of the benefit of PCI. 8 The treatment of stable CAD represents a preferencesensitive decision with comparable, alternative treatments. Shared decision making (SDM), as a "process of interacting with patients who wish to be involved in arriving at an informed, values-based choice among…medically reasonable alternatives," 9 offers a unique approach to healthcare delivery of patients with stable CAD. Decision aids may help Background-Percutaneous coronary intervention (PCI) for stable coronary artery disease does not reduce the risk of death and myocardial infarction compared with optimal medical therapy (OMT), but many patients think otherwise. PCI Choice, a decision aid (DA), was designed for use during the clinical visit and includes information on quality of life and mortality outcomes for PCI with OMT versus OMT alone for stable coronary artery disease. Methods and Results-We conducted a randomized trial to assess the impact of the PCI Choice DA compared with usual care when there is a choice between PCI and optimal medical therapy. Primary outcomes were patient knowledge and decisional conflict, and the secondary outcome was an objective measure of shared decision making. A total of 124 patients were eligible for final analysis. Knowledge was higher among patients receiving the DA compared with usual care (60% DA; 40% usual care; P=0.034), and patients felt more informed (P=0.043). Other measures of decisional quality were not improved, and engagement of the patient by the clinician in shared decision making did not change with use of the DA. There was evidence that clinicians used the DA as an educational tool. Conclusions-The PCI Choice DA improved patient knowledge but did not significantly impact decisional quality. Further work is needed to effectively address clinician knowledge gaps in shared decision-making skills, even in the context of carefully designed DAs. Clinical Trial Registration-URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01771536.(Circ Cardiovasc Qual Outcomes. 2016;9:767-776.

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Shared Decision-Making Strategies for Best Care: Patient Decision Aids

Cited by 65 publications

References 0 publications

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values

Relationships Among Financial Distress, Emotional Distress, and Overall Distress in Insured Patients With Cancer

PCI Choice Decision Aid for Stable Coronary Artery Disease

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