Decision Aids in the United States: the Patient Response

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Published: Dec 15, 2015
DOI: https://doi.org/10.5750/ijpcm.v5i3.517
Keywords:
Shared decision making patient decision aids informed choice patient education person centered care health literacy

Main Article Content

Richard Wexler
Healthwise Informed Medical Decisions Foundation
Bethany S. Gerstein
Harvard University, PhD Program in Health Policy, Harvard Business School, Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA.
Charles Brackett
Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Lyle J. (LJ) Fagnan
Oregon Rural Practice-based Research Network (ORPRN), Oregon Health & Science University, Portland, OR, USA.
Kathleen M. Fairfield
Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME 04102, USA.
Dominick L. Frosch
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA Department of Medicine, University of California, Los Angeles, CA, USA
Carmen L. Lewis
Department of Medicine, Division of General Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Lawrence Morrissey
Central Pediatrics Woodbury, MN, USA
Leigh H. Simmons
John D. Stoeckle Center for Primary Care Innovation, General Medicine Division, Massachusetts General Hospital, Boston, MA, USA.
David Swieskowski
Mercy Medical Center, Des Moines, IA, USA.
Yuchiao Chang
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
Floyd J. Fowler
Informed Medical Decisions Foundation/Healthwise, Boston, MA, USA.
Michael J. Barry
Informed Medical Decisions Foundation/Healthwise, Boston, MA, USA.

Abstract

Background:  In the United States and elsewhere, a growing chorus of voices is calling for the routine use of patient decision aids (DAs) and shared decision making (SDM) in day-to-day care.  A frequently cited barrier to this approach is the belief that many patients will not be able to understand key clinical information and/or prefer to delegate decision making to providers.  These beliefs, often held by providers, are thought to be particularly applicable to elderly and less educated patients.Objectives: To test the perception that older and less educated patients will not value or benefit from DAs.Research design: Self-administered questionnaires completed by patients after viewing DAs.Subjects: 3001 patients in six primary care practice sites facing one of sixteen common medical decisions.Measures: Amount of DA viewed, knowledge about medical tests or treatments, DA rating, and importance of receiving DAs from providers.Results: Across age and education level, higher self-reported exposure to the DAs was associated with higher knowledge scores. Those over 65 and those who had not attended college had knowledge gains at least has high as those in other groups. There were no statistically significant differences by age or education in patient assessment of the importance of using DAs.Conclusions: Patients in primary care settings in the U.S. learn from DAs, rate them highly, and believe that providers should make them available in ways that are mainly independent of patient age or formal education.

Article Details

Issue
Vol. 5 No. 3 (2015)
Section
Regular Articles
Author Biography

Richard Wexler, Healthwise Informed Medical Decisions Foundation

Richard Wexler, MD, is the Chief Clinical Integration Officer for Healthwise. He has 25 years of experience leading quality improvement initiatives and 6 years of experience designing and implementing shared-decision-making programs. His recent work focuses on organizational change and clinician training. Dr. Wexler works closely with provider organizations across the country and is widely recognized as a leader in shared decision making. Before joining Healthwise, Dr. Wexler worked in care management, health plan and public health settings He practiced gastroenterology in Maine for 12 years following his training at Johns Hopkins, the University of Vermont, and Harvard University.

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