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June 5, 2013 Readers Write No Comments

High-Tech Patient Engagement Tools Empower Patients for Shared Decision Making
By Corey Siegel, MD

6-5-2013 9-36-49 PM

Shared decision making (SDM) is one of few approaches proven to achieve the Institute for Healthcare Improvement’s Triple Aim of improving the patient experience, improving the health of populations, and reducing the per capita cost of healthcare.

The Patient Protection and Affordable Care Act (ACA), as well as organizations driving health policy such as the National Quality Forum, embrace SDM. Yet the roadblock to widespread implementation has been the lack of access to the technology and tools to make it a reality.

The process of SDM engages patients in treatment decisions to optimize the likelihood that a chosen therapy matches their personal preferences for care. Decision aids are standard SDM tools, which are used to present evidence-based data in a patient-friendly manner to help patients with preference-sensitive decisions.

Not all care decisions are preference sensitive, and not all patients are interested in being part of SDM. The responsibility of the provider is to identify how much of a role patients want, and then determine which decisions require their input to provide the best patient-centered care.

The overall goal is to involve patients in decisions so that they are educated about their options, confident in the plan, adherent to their therapy, and ultimately have a better quality of life.

One example is a new initiative by the Crohn’s & Colitis Foundation of America (CCFA) in collaboration with Dartmouth-Hitchcock Medical Center and Emmi Solutions to give its gastroenterologist members access to an interactive, Web-based patient education and engagement tool. The 25-minute decision aid combines voice, image, and on-screen text to explain Crohn’s disease and the potential natural progression and risks, as well as the benefits and tradeoffs of various treatment options.

Treatment options for patients with Crohn’s disease are improving. But because it’s a complex disease and some of the treatments have serious risks, too often, patients delay critical treatment until they are experiencing significant symptoms, and by then, it may be too late. The decision aid serves as an effective tool to engage the patient and open a dialogue with the physician, who can answer any of the patient’s questions or concerns.

Patients access the tool at their convenience from any computer using a unique access code provided by the physician in less than a minute. The technology enables providers to track compliance and measure outcomes. It can be used in a standalone mode or fully integrated into existing electronic health records or patient portals.

The goal is not to replace physician-patient conversations but to make these conversations more fruitful. The goal is to support physicians and empower patients so that SDM results in optimal treatment decisions for each patient.

SDM is a field that will continue to evolve, and hopefully the number of easily accessible patient tools will grow.

A simple approach to decide whether a SDM approach is right in certain circumstances is to consider these four questions:

  • Is there an established standard of care for the clinical scenario or is there equipoise?
  • What are the stakes? Is this a decision about which antibiotic to use, or do side effects such as death and cancer need to be discussed?
  • Does your patient want to be part of a shared medical decision?
  • What are the information needs of your patient?

Considering these questions and reviewing options with your patients will be a step forward in SDM and better-informed treatment decisions.

Corey Siegel, MD is director of the Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, recent co-chair of CCFA’s Professional Education Committee, and medical advisor to Emmi Solutions.

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