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?
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
The PCORI-funded CODA trial found that using antibiotics to treat appendicitis worked as well as surgical removal of the appendix for most patients in the three months post-treatment, as reported in the New England Journal of Medicine. Health outcomes were similar for each treatment group. More than 70 percent of patients on antibiotics avoided having surgery and missed less time away from work or school, but nearly 30 percent ultimately needed to have their appendix removed.
The PCORnet® Bariatric Study, which is studying outcomes among patients who undergo common weight-loss surgeries has published several papers in prominent medical journals. One JAMA Surgery article compared diabetes remission outcomes among patients who underwent gastric bypass and gastric sleeve surgeries. Another JAMA Surgery article detailed five-year outcomes, finding that patients who had gastric bypass were significantly more likely than those who had gastric sleeve to end up back in the hospital in the years following surgery.
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.
Shared Decision Making Study Spotlights
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.
Candid discussions occurring early in a patient's diagnosis are paramount. A pair of caregivers say that such conversations and decision aids, such as pamphlets and videos, can play an important role in helping patients and their families make realistic treatment choices. They also share their perspectives as stakeholders on the PCORI-funded DECIDE-LVAD trial and a Dissemination and Implementation project.