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Decision-Aids for Helping Consumers Make Informed Medical Decisions

Posted Oct 05 2009 10:02pm

Who is the best person to advise you on important medical decisions? Nearly everyone would respond to this question by citing their family physician. It turns out that this ain't necessarily so according to a recent article (see: Weighty Choices, in Patients’ Hands ). Here are some of the details:

For patients [with serious diseases], the current health-policy debate comes down to a very personal issue: how to make ever-more-complex decisions when faced with multiple options, each with no clear advantage and with risks and harms that patients may value differently. Preliminary data from the National Survey of Medical Decisions, conducted by researchers at the University of Michigan, showed that doctors are more likely to discuss the advantages of treatments while giving short shrift to the disadvantages. The study also found that doctors often offer their opinion but much less frequently ask the patient’s own opinion....Though decision-aid programs cost money to deliver, they appear to save money in the long run. Studies show that when patients understand their choices and share in the decision-making process with their doctors, they tend to choose less-invasive and less-expensive treatments than they would have otherwise received. A number of states and policymakers in Washington are considering legislation that would provide funding to study the use of shared-decision-making programs and in some cases require such programs to be offered to patients as part of the informed-consent process. A growing number of hospitals, medical groups and health plans are using decision aids offered by the Foundation for Informed Medical Decision Making, which grew out of research at Dartmouth University, for conditions where there is no consensus as to the best course of treatment. The foundation offers decision aids for 23 diseases and conditions including breast and prostate cancer, knee surgery, end-of-life care and uterine fibroids. Health Dialog, its for-profit partner, provides the programs to health plans and employers reaching about 20 million beneficiaries. Using claims data, Health Dialog determines which patients might benefit from shared decision making, then reaches out to them by mail or phone to offer informational DVDs and telephone-coaching sessions to help make decisions.

I believe, as stated above, that physicians are more like to discuss the advantages and benefits of treatment than the disadvantages. In effect, they are trained to "sell" various treatments and therapies. After all, that is the business that they are in and all of them firmly believe in what they are "selling." Coupled with this, there is always the problem that surgeons like to operate and oncologists are trained to offer chemotherapy to nearly all of the patients who are referred to them. Some of these problems can be reduced by the use of multidisciplinary teams (MDTs) in cancer hospitals and breast clinics (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.). One of the antidote to this problem is the well-informed patient and the web is one of the vehicles for educating healthcare consumers.

I think that it would be a bit of a stretch to suggest that all patients should make use of the "decision-aids" described above to help them navigate through complex medical decisions. The use of such products could seriously disrupt the critical patient-physician relationship. Obviously, health plans and employers, as described above, could mandate their use because they are paying the medical bills. The experience gained in these new approaches will be invaluable. Meanwhile, it would help if these "decision-aids" as well as supplemental educational materials could be made more broadly available on the web. In this way, motivated patients needing help in making significant medical decisions could have access to them in parallel with discussions with their personal physicians. Ideally, the advice obtained on the web would reinforce the same decisions arrived at in discussions with their physicians. If not and perhaps for some patients, these decision-aids could guide them in a better direction based on their individual needs.

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