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Tuesday, 17 October 2006
38

TOOLKITS FOR INTEGRATING DECISION SUPPORT/PATIENTS' DECISION AIDS INTO SPECIALTY CARE

Kate F. Clay, MA, BSN1, E. Dale Collins, MD1, Stephen Kearing, MS2, Caroline P. Moore, MPH1, James N. Weinstein, DO, MS3, Ivan Tomek, MD4, and Hilary A. Llewellyn-Thomas, PhD2. (1) Dartmouth Hitchcock Medical Center, Lebanon, NH, (2) Dartmouth Medical School, Hanover, NH, (3) Dartmouth-Hitchcock Medical Center, Lebanon, NH, (4) Dartmouth Hitchcock Medical School, Lebanon, NH

Purpose: To date: a) evidence that Decision Support/Decision Aids (DS/PtDAs) help pts. make informed, values-based choices in close-call situations; and b) current demonstration projects show that DS/PtDAs can be seamlessly integrated into the process of care in an academic medical center. Objective: Use this experience to develop and test toolkits that can guide DS/PtDA implementation strategies in other clinical settings. Ultimate contribution: Set of tested templates for effective, sustainable practice models for DA/PtDAs in general and specialized practices could then be widely disseminated to other institutions. Methods: Web-based implementation toolkits for specialized practices have been created in: early stage breast cancer and total joint replacement. Common elements for both toolkits: a) clinician training guides; b) flowcharts pinpointing DS/PtDAs in care pathway; c) electronic collection of self-reported data about clinical profile, health status, and decision process (e.g., decisional conflict); d) printed summary reports to clinicians and patients; e) video-based PtDAs; f) electronic collection of self-reported post-PtDA data about decision process and decision quality (i.e., knowledge, preferences, actual choice); g) outcome reports to key individuals. Results Patient application groups: n = 132 in early stage breast cancer, n = 75 in total joint replacement. In both groups, all elements of toolkits performed well, for patients and practitioners. Able to collect clearly interpretable process and outcome data. [e.g., Patients informed (mean knowledge score: 85% 92%); have low levels of decisional conflict (mean: 6 14); high satisfaction with preparation for decision making (mean: 73 - 91); and would recommend DS/PtDA service to others (93% 100%).] Illustrative examples demonstrating training guides, flowcharts, sample electronic data capture formats, interactive and downloadable tools, sample summary reports can be presented on laptop computers at the SMDM Annual Meeting poster presentation. Conclusions: The toolkit concept is feasible and based on clear principles of design, measurement, and modification. It consists of core elements and modules adapted to the unique characteristics of condition-specific decision situations. It could be readily translated to other clinical settings. Its development offers significant potential contribution to wide dissemination of systematic yet individualized strategies for DS/PtDAs in clinical care.


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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)