Shared Decision Making
PCORI Answers Critical Questions
Evidence gaps can make it difficult to know which decision aids and shared decision making methods are most effective. PCORI funds studies answering questions about which tools and approaches can be most effective at helping patients and clinicians come to treatment decisions, such as:
Clinician: Working in an emergency department, I see a lot of people brought in with chest pain, but not all really need a hospital stay. What is the best way of sharing evidence to help them make informed decisions about their care?
Counselor: I run a program for people trying to quit smoking. Is there something that would be more effective than informational brochures to help my clients decide whether lung cancer screening is right for them?
Patient: I don’t like taking painkillers every day for my lower back pain, but I worry that surgery would keep me out of work for a long time. How can I let my doctor know what’s important to me, so we can reach the treatment decision that will work best for me?
The Significance of Shared Decision Making
There is seldom a one-size-fits-all healthcare choice that works well for every person. Shared decision making helps people and their healthcare providers communicate better. It encourages patients to more actively participate in their care decisions, increasing the chance that they will follow through and be satisfied with the outcomes.
Study Results that Support Better-Informed Decisions
Head CT scans may detect evidence of brain injury in children after minor head trauma, but they also expose children to radiation. This study found that a decision aid used in emergency departments helped parents make better-informed decisions about whether their children would receive CT scans. Parents who used the aid had a better understanding of the symptoms of concussion, their child’s relative risk of brain injury, and the pros and cons of head CT scans.
Although chest pain sends many people to emergency departments, a significant percentage are not having a heart attack or other serious heart problem. Evidence from this study showed the benefits of patients and doctors using a shared decision making tool to guide next steps.
|Five-Year Outcomes for Common Bariatric Surgeries
The PCORnet® Bariatric Study—which is using data from PCORnet, The National Patient-Centered Clinical Research Network—to study outcomes among patients who undergo common weight-loss surgeries has published several papers in prominent medical journals. The most recent clinical findings, published in JAMA Surgery, are on diabetes remission outcomes among patients who underwent gastric bypass and gastric sleeve surgeries. Another article, also published in JAMA Surgery, details the five-year outcomes of patients who underwent either gastric bypass or adjustable banding, finding that gastric bypass patients were significantly more likely than gastric sleeve patients to end up back in the hospital in the years following surgery.
Shared Decision Making Study Spotlights
PCORI-funded studies provide evidence that can help support shared decision making. This study helps patients and their clinicians choose among the many available treatments for prostate cancer.
This study looks to understand how best to help parents of young children with sickle cell disease (SCD) and their clinicians make a treatment decision around hydroxyurea. Hydroxyurea is a medication recommended for very young children with SCD, but many parents have concerns about its safety and long-term side effects that if not addressed can disproportionally inform their decision.
David Arterburn, MD, MPH, of Kaiser Permanente Washington Health Research Institute, discusses his PCORI Dissemination and Implementation Award, which is taking the findings from The PCORnet® Bariatric Study to create decision aids for patients and providers to help them make better-informed choices among their options for weight loss surgery.
2019 PCORI Annual Meeting Breakout
Navigating Complex Choices: Shared Decision Making across the Care Continuum
This breakout session provided examples of shared decision making across the care continuum and across the lifespan, with panelists highlighting how shared decision making includes evaluation of options based on care goals, concerns, and personal context of individuals.