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One issue that often goes neglected in this debate about eliciting the patients’ values & preferences (V&P) is that we simply do not know what is the best way
to do it! There is no such a thing as “gold standard” methodology for elicitation of V&P- until it is generated (and applicable within a reality of clinical encounter) the shared decision-making will remain an aspiration rather a realistic goal. (I know many
of us use decision aids, pictograms, SG, TTO, DVAs, etc but we simply do not know if any of the described methods in the literature facilitate better decision-making or not).
Ben djulbegovic
From: Evidence based health (EBH) [mailto:[log in to unmask]]
On Behalf Of k.hopayian
Sent: Tuesday, July 02, 2013 1:57 PM
To: [log in to unmask]
Subject: Re: Shared Decision Making Conference Lima
On fascinating thing about honest communication with patients is that many more will decline to have a treatment when given information than when given the recommendation alone. (Steel N. Thresholds for taking antihypertensive drugs in
different professional and lay groups: questionnaire survey. BMJ. 2000;320(7247):1446-1447. Man-Son-Hing M, Gage BF, Montgomery AA, Howitt A, Thomson R, Devereaux PJ et al. Preference-based antithrombotic therapy in atrial fibrillation: implications
for clinical decision making. Med Decis Making. 2005;25(5):548-559. Trewby PN, Reddy AV, Trewby CS, Ashton VJ, Brennan G, Inglis J. Are preventive drugs preventive enough? A study of patients’ expectation of benefit from preventive drugs.
Clin Med. 2002;2(6):527-533.)
This has led to an interesting conflict in the UK where there is a form of performance management of general practice called the Quality and Outcomes Framework. QOF rewards GPs
for hitting certain targets in chronic disease management, such as proportion of patients achieving pre-set HbA1c or BP levels. Sounds good? No, because it potentially penalises GPs who inform patients about risks and benefits! We are allowed to except patients
from the framework if they decline a test or treatment but doing so makes one an outlier and so open to investigation by the authorities. I argue that one should be proud of such an investigation at
http://www.angliangp.org.uk/EvidenceBased/ExceptionReportingQualityMarker2013%20copy.pdf.
Kev Hopayian
On 27 Jun 2013, at 17:25, Dean Giustini <[log in to unmask]> wrote:
Shared decision-making in medicine (an introduction)
http://hlwiki.slais.ubc.ca/index.php/Shared_decision-making_in_medicine
On 27 June 2013 07:54, Susan Fowler <[log in to unmask]> wrote:
Here are resources on health literacy, consumer health, and presenting medical issues in plain language…
In particular, note that...The federal government passed the Plain Writing Act of 2010 and has a whole site dedicated to it that includes federal plain writing
guidelines: http://www.plainlanguage.gov/howto/guidelines/FederalPLGuidelines/TOC.cfm
There has been a real paradigm shift in relation to health literacy. To get an idea of the overall effort and the research that is behind it, check out “New
Federal Policy Initiatives to Boost Health Literacy Can Help the Nation Move beyond the Cycle of Costly Crisis Care’”
Here are some other resources:
US Department of Health and Human Services: Quick Guide to Health Literacy: http://www.health.gov/communication/literacy/quickguide/
National Action Plan to Improve Health Literacy: http://www.health.gov/communication/HLActionPlan/
AHRQ Health Literacy Universal Precautions Toolkit: http://www.ahrq.gov/qual/literacy/
Teaching Patients with Low Literacy Skills (this is considered THE classic text on health literacy):http://www.hsph.harvard.edu/healthliteracy/resources/doak-book/
Helen Osborne's "Health Literacy from A to Z": http://www.healthliteracy.com/
US Department of Health and Human Services: Health Literacy Online: http://www.health.gov/healthliteracyonline/
--
Susan Fowler, MLIS
Medical Librarian
Evidence at Becker:
http://beckerguides.wustl.edu/ebm
Systematic Reviews Guide:
http://beckerguides.wustl.edu/SystematicReviews
Becker Medical Library, Washington University in St. Louis
314-362-8092
[log in to unmask]
On Thu, Jun 27, 2013 at 6:53 AM, Glyn Elwyn <[log in to unmask]> wrote:
Dear Colleagues
Just joined this listserv - you may have already seen this - so apologies for repeats.
A Mayo-led team (Montori/LeBlanc) organised the 7th conference in Lima (terrific by the way), where Gordon Gyuatt gave an excellent keynote.
Keynote: EBM needs SDM needs EBM with Dr. Gordon Guyatt
http://isdm2013.org/video-archive/
Others from the EBHC community gave workshops. Interesting to reflect in 2013 how I got into this SDM area from a kick-off in Oxford-based week-long events many years ago, where Greenhalgh, Milne, Sackett, and many others were strong on the need for evidence
etc.
High time even more bridges were built between EBHC (sample based data) and the need to respect individual, yet informed, preferences (personal level decision making).
There was evidence of culture dissonance for sure - the word 'recommendation' - weak or strong - was under debate in one workshop where GRADE was under the spotlight. Yet the mood was one of a genuine attempt to integrate these population / individual stances
somehow. Looking forward to those conversations.
Glyn
Professor Glyn Elwyn
BA MB BCh MSc FRCGP PhD
[log in to unmask]
The Dartmouth Center for Health Care Delivery Science | USA
The Dartmouth Institute for Health Policy and Clinical Practice | USA
Scientific Institute for Quality of Healthcare | University Nijmegen Medical Centre | Netherlands.
Cochrane Institute for Primary Care and Public Health | Cardiff University | UK
@glynelwyn Twitter
glynelwyn Skype
+1-603-646-2295 Desk
+1-603-729-6694 Cell
+1-603-646-2553 Robin Paradis Montibello