Statin Choice Decision Aid ShareDecision Making SCIP Shared Decision Making Shared Decision Making Glasziou and Haynes ACP JC 2005 Promote a process where patients and clinicians make a choice together ID: 762378
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Statin Choice Decision AidShare-Decision Making SCIP
Shared Decision Making
Shared Decision Making Glasziou and Haynes ACP JC 2005
Promote a process where patients and clinicians make a choice together.Clinicians are the expert on evidence-based medicine and guidelines Patients are the expert on his or her preferences, values, and personal context. SDM acknowledges that both perspectives contribute equal weight to decision making. What is Shared Decision Making? Ting HH, Brito JP, Montori VM. Shared decision making : science and action. Circ Cardiovasc Qual Outcomes. 2014;7:323–7 .
The body of evidence Systematic review 115 RCTs of shared-decision making interventions. The results (decision aids compare to usual care) show that : Increase patient involvement by 34% (+++-)Increase patient knowledge of options by 13% (++++) Increase consultation time by ~2.6 minutes Reduce decisional conflict by ~7% Reduce % undecided by 40% No consistent effect on the choice patients make, adherence, health outcomes or costs. Stacey D et al. Cochrane review 2014
Decision Aids
Decision Aids - Examples Decision aid Evaluation Risk communication tools Statin Choice (primary care) Feasible, effective Independently validated Multicenter trial completed Implemented in EHR Chest pain Choice (emergency) Feasible, effective (Emergency) Multicenter trial seeking funding Aspirin Choice (primary care) Implemented in EHR without evaluation Osteoporosis Choice (primary care) Feasible, effective EHR implementation ongoing PCI Choice (cardiology) Ongoing AMI Choice (hospital) Feasible, effective (hospital) Issue cards DM2 Med Choice Feasible, effective Multicenter trial ongoing Implemented in EHRDepression ChoiceOngoing
Statin Choice Decision Aid
Statin Choice Decision Aid
Statin Choice Decision Aid
Statin Choice Decision Aid https://statindecisionaid.mayoclinic.org /
Mayo Experience Compared to usual care, patients using the decision aid were 22 times more likely to have an accurate sense of their baseline risk and risk reduction with statins. Weymiller et al. Arch Intern Med 2007
Mayo Experience Age : 40-92 ( avg 65)Primary care, ED, hospital, specialty care 74-90% clinicians want to use tools againAdds ~3 minutes to consultation60% fidelity without training20% improvement in patient knowledge 17% improvement in patient involvement
Decision Aid
Decision Aid The decision aids tool were made so that they can take place with minimal training. http :// statindecisionaid.mayoclinic.org
It is about the patientIt is the right thing to do. Why to do it?
Statin Choice Decision Aid
Implementation into the EMR
Decision Aid Empathic decision making Partnership Dance across models Support deliberation
Decision Aid Incorporate research evidence and clinician’s expertise into patient decisions
It is feasible to promote evidence-based conversations during the clinical encounters with patients with chronic conditions. Decision aids designed for this purpose are efficient and effective in promoting shared decision making. Tools tested in randomized trials and proven effective are available for free. Partners to get to routine use in practice Conclusions