Dominick Frosch, Many Miles to Go……Implementing Shared Decision Making in Routine Practice
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April 18, 2018 Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification. For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
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Dominick Frosch, Many Miles to Go……Implementing Shared Decision Making in Routine Practice
- 1. Many Miles to Go…… Implementing Shared Decision Making in Routine Practice Dominick L. Frosch, PhD Senior Scientist & Chief Care Delivery Evaluation Officer Palo Alto Medical Foundation Research Institute April 18, 2018 The Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School
- 2. A common sentiment about SDM among healthcare providers: “We already do that all the time.” 2
- 3. Reality check 3 Most people don’t feel comfortable disagreeing with a physician’s recommendation 93.1% 94.0% 14.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Would ask questions Would discuss preferences Would disagree N=1340, p<.0001 Adams, Elwyn, Légaré & Frosch, 2012 Archives of Internal Medicine
- 4. Reality check 4 Patient Education & Counseling, 2016 Annals of Family Medicine, 2013
- 5. Reality check 5 BMC Medical Informatics & Decision Making, 2013 “The studies reported here paint a picture of professional indifference and organizational inertia, and where other priorities take precedence….Reliance on clinicians to refer patients to these tools leads to limited utilization, and so using system-based approaches, where feasible, may help reach more patients. Unfortunately, system approaches rely on identifying eligible patients ahead of visits and this task is only possible for a limited number of conditions. Even when this is feasible, logistical and infrastructure challenges still impede integration into practice.”
- 6. Reality check 6 12% 5% 12% 0% 20% 40% DESI Use at 4 months DESI SMA Combined Journal of General Internal Medicine, 2015
- 7. 7 Bright spots Health Affairs, 2016 BMJ Quality & Safety, 2017
- 8. 8 Bright spots Journal of General Internal Medicine, 2016 Journal of Asthma, 2014
- 9. Why certification is critical 9 BMJ Quality & Safety, 2016