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Tuesday, 19 October 2004

This presentation is part of: Poster Session - Clinical Strategies; Judgment and Decison Making

CAN DECISION SUPPORT BE SUCCESSFULLY INTEGRATED INTO CLINICAL CARE?

Caroline P. Moore, MPH1, E. Dale Collins, MD1, Kate F. Clay, MA, BSN2, Stephen Kearing, MS3, Susan M. Gallagher, BS4, David Amon, BA4, Hilary A. Llewellyn-Thomas, PhD5, and Annette M. O'Connor, PhD6. (1) Dartmouth Hitchcock Medical Center, Comprehensive Breast Program, Lebanon, NH, (2) Dartmouth Hitchcock Medical Center, Center for Shared Decision Making, Lebanon, NH, (3) Dartmouth Medical School, Community and Family Medicine, Hanover, NH, (4) Dartmouth Medical School, BioInformatics, Lebanon, NH, (5) Dartmouth Medical School, Center for Evaluative Clinical Sciences, Hanover, NH, (6) University of Ottawa, Faculty of Health Sciences & Faculty of Medicine, Ottawa, ON, Canada

Purpose: The purpose of this study is twofold: to explore the feasibility of integrating decision support into clinical care; and to determine whether such integration yields benefits for both patients and providers.

Methods: From Feb. 2003 – Mar. 2004, 102 early stage breast cancer patients viewed a Shared Decision-Making© video on therapeutic options prior to surgical consultation. Starting March 2004, newly diagnosed patients with Stage 0-2 cancer (n=35) were additionally asked to complete a computerized questionnaire documenting: physical and emotional health; distress levels; and decisional needs (e.g. understanding of options, social pressures, and values clarity). Responses were instantly summarized in a report and social workers were automatically alerted to intervene if a patient reported high levels of distress. Patients then viewed the video and proceeded to surgical consultations. To assess feasibility, we surveyed patients about questionnaire content, response burden, and relevance to care; we surveyed staff and surgeons about impact on scheduling and clinic flow. To assess benefits, we utilized survey data of the patients’ perceptions of the video, as well as measuring the number of interventions for distress, and physician and staff response to the new process.

Results: Feasibility: All eligible patients have completed the new protocol. Most (28/35) were satisfied with the questionnaire’s content and length. No physicians experienced clinic disruption. Staff members reported some problems scheduling surgery appts, but no problems scheduling the intake (video and questionnaire appointment). Benefits: The video helped most (97/102) patients to: organize thoughts, identify questions, talk with their doctor, and make better decisions. Many questionnaire subjects(19/35) reported distress or mental health symptoms that triggered intervention. All staff (n=6) and physicians (n=4) agreed that adding decision support to routine care improved services, and that benefits outweighed the burden. All physicians agreed that the report was helpful. (Additional data will be available at presentation.)

Conclusions: Integrating decision support with clinical care is operationally feasible and yields benefits for patients and physicians. Overall, the clinic’s transition to the new protocol has been nearly seamless. Results demonstrate a need for distress intervention, which can be folded into decision support. The video and report help prepare both patients and physicians for the initial consultation. With further testing this process can be adapted to a variety of health conditions.


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See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)