This presentation is part of: Oral Concurrent Session B - Health Services Research
A CLINICAL CENTER FOR SHARED DECISION MAKING: THE FIRST FIVE YEARS
Hilary A. Llewellyn-Thomas, PhD, Dartmouth Medical School, Center for Evaluative Clinical Sciences, Hanover, NH, Kate F. Clay, MA, BSN, Dartmouth Hitchcock Medical Center, Center for Shared Decision Making, Lebanon, NH, and Darleen Mimnaugh, MA, Dartmouth Medical School, Center for the Evaluative Clinical Sciences, Hanover, NH.
Purpose: The Center for Shared Decision Making (CSDM) at Dartmouth-Hitchcock Medical Center (DHMC) is the world’s first hospital-based clinic designed to provide patients facing close-call, preference-sensitive health care choices with an individualized decision support service. Methods: The CSDM is a fully-staffed office suite located in the DHMC’s main atrium. Depending on patients’ presenting characteristics, 4 different levels of intensity of decision support are provided. Level 3 involves walk-in/referred patients for whom decision support is provided using the Ottawa Personal Decision Guide + condition-specific decision aids (DAs; e.g. PSA screening, elective back surgery, breast or prostate cancer, etc.). These Level 3 patients complete evaluative questionnaires about this decision support service. Results: To date, over 1500 patients have received Level 3 support. Age and sex distributions are consistent with those of the underlying patient populations. The majority have >high school education. After viewing their condition-specific DA, they report the following patterns. Uncertainty: Fewer patients are unsure of their treatment preference (21%), compared with before (30%). Comprehension: Positive evaluations range from 84% (re. options’ risks) to 92% (re. overall comparisons of the options). Values: Positive evaluations range from 74% (re. options’ risks) to 78% (re. options’ benefits). Making a Choice: 86-87% report enough support/free of social pressure; 68% have enough advice; 57% are sure about what to choose, while 32% remain uncertain. Decision Confidence: For the majority, the DAs helped them to organize thoughts (90%); consider pros and cons (92%); identify questions to ask (90%); consider their own involvement in decision making (91%); prepare to make a better decision (88%). Effects on MD-Patient Communication: For the majority, the DAs helped them to know what to expect at their next visit (72%); improve their use of clinic time (69%); make visits smoother (73%); and communicate with their MD (91%), while not negatively affecting the relationship with their MD (89%). Conclusions: It is possible to conduct quality assurance assessments of a formal decision support service for patients in a busy clinical setting. These assessments indicate a) that the service generally encourages effective decision making in close-call situations in which there is no single “best” option; and b) that there are sub-groups of patients who may benefit from more intensive levels of decision support (e.g., the 32% who are still “uncertain”).
