Opportunity Knocks Richard Wexler, MD rmwexlermd@gmail.com
Opportunity realized Lars Rasmussen Jens Rasmussen
Presentation outline Implementation framework for SDM programs Communications framework for SDM conversations Communication training and technology
SDM program plan elements Patient decision aids Patient-centered Communication training SDM communication training
Leadership
Coordinating the effort Training Decision aids SDM conversation
Implementation framework for SDM programs Training Leadership Training Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
Engaging providers and staff in SDM MOTIVATION = Importance + Confidence
Decision aid distribution timing Before visit During visit After visit
Presentation outline Implementation framework for SDM programs Communications framework for SDM conversations Communication training and technology
SDM conceptual framework* *Draws from Volk s 21 SDM competency themes 1 & Makoul s 9 essential elements 2 Options Invite Risks & Goals & Deliberate & Decide Implement Benefits Concerns Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information. Volk et.al. BMC Med Inf and Dec Mak 2014, 14:95 Makoul & Clayman, Patient Educ Couns 2006; 60:301-312
Invite Options Risks and benefits Goals and concerns Deliberate and decide Implement Silverman J., S.M. Kurtz and J. Draper(1998)
Presentation outline Implementation framework for SDM programs Communications framework for SDM conversations Communication training and technology
SDM Training Review We know what providers have difficulty with: Understanding evidence and communicating risk Determining patient role preference Eliciting patient preferences Listening Inventory of SDM training programs 1 shows: Great variance in design and content Little evaluation activity Effectiveness remains largely unknown 1 Legare F, et al. Patient Educ Couns 2012; 88:159-169.
Adult Learning Theory Review People learn new skills best when: They re motivated Prior knowledge is acknowledged Prior misconceptions are corrected and known barriers are addressed They have lots of opportunities to practice They receive immediate feedback The content and experiences are relevant to their work or life
Training program design Scalable and flexible delivery 90 min, online Focuses on most challenging competencies Directly confronts barriers Emotionally and intellectually engaging Uses authentic scenarios Lots of opportunities for practice
SDM: What s at Stake? Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
The Six Steps of Shared Decision Making Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
When Would You Use SDM? Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
What s Stopping You? g You? Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
Listening for Patients Goals and Concerns Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
Practice the Conversation Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
Practice the Conversation 2 1 2 3 4
SDM With and Without Decision Aids Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
SDM Implementation: An Overview Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
Assessment of SDM Conversation Skills Healthwise, Inc. www.healthwise.org. Reprinted with permission. Healthwise disclaims any warranty or liability for your use of this information.
Evaluation Group Health Cooperative Seattle, Washington USA
Provider SDM skills course Orthopedic & Primary Care Providers given access to online course Successful completion yields $100 gift card + 1.5 hours of CME credit Course available for 6 weeks, providers may access at any time Assessments/Surveys at 3 time points: Pre-Course Assessment Post-Course Assessment Skills Course Follow-Up Assessment 6 Weeks
Provider SDM skills course 49 Providers invited to participate 39 completed the course (80%) 28 completed Pre- and Post-Course assessments (57%) 23 also completed the follow-up assessment (47%) Pre-Course Assessment Post-Course Assessment Skills Course Follow-Up Assessment 6 Weeks
Provider attitudes: Did you notice reluctance in your patient subgroups to engage in SDM? Before Training 48% 45% 42% After Training 36% 15% 15% 9% 9% 3% 3%
Provider knowledge: Mean Percent Correctly Answered 90% 74% 61%
Providers: program evaluation 39% 43% 7% 11% 32 % 68 %
Patient Cohorts Patients who visited Primary Care and Orthopedic providers surveyed before the SDM Skills Course was made available Patients who had visits with the providers after they completed the skills course were also surveyed Questions about SDM interactions with providers if they discussed: Starting a new Rx medication Having preventive screening for cancer Whether or not to have surgery 58% ortho patients & 54% primary care patients discussed relevant topic Patient Surveys: Baseline Skills Course Available Patient Surveys: Post-Implementation 8 Weeks 6 Weeks 4 Weeks 8 Weeks
Patients: Interactions with Providers before & after training Before Training 79% 75% 78% 75% 70% 71% After Training 48% 40% 51% 49% 56% 51%
Limitations Sample size is small Some providers were previously trained in SDM skills No way of knowing how far along patients are in their decision-making journey Some patients may have been primed with DA s
Conclusions Half of patient visits included discussion of a topic appropriate for SDM Feasible for providers to participate in SDM Skills Course Most of those invited completed the course Most were interested in similar courses Most reported at least some information was new to them 65% maintained knowledge gain 4-6 weeks after completing the course
SDM
Opportunity realized
Thank you! Tak!