2 PLEASE MUTE YOUR AUDIO AND VIDEO
Disc Discla laim imer: Providing ideas and not legal advice All information presented as of October 21, 2020
Patient Decision Aid Series: Cutting ng E Edg dge P Patient nt Edu ducation n & Inform rmed ed C Consen ent f for P r Pri rimary ry Brea reast Augme ment ntation Made Possible by an Educational Grant from Allergan Aesthetics
Panelists CHELSEA HAGOPIAN, DNP, LAURIE A. CASAS MD, FACS MELINDA HAWS, MD APRN, AGACNP-BC
6 why is shared decision-making important in plastic surgery? “ A [shared decision-making] process of communication, if properly performed and documented in the patient’s record, would constitute perfecte ted informe med c conse sent .” Birkeland S, Moulton B. Shared Decision-Making and Liability in Aesthetic Surgery. Aesthet Surg J. 2016;36(8):NP254-NP255.
7 Download the PDA at: www.surgery.org/pda
Agenda 01 over erview iew o of patien ient dec ecis isio ion a aids ds ( (PDAs) & & shared ed d decis isio ion-maki king 02 highlight k t key f featu atures o of the PDA & & relevan ant r t research
patient decision aids & overview & published standards shared decision-making
what is a patient decision aid? 03 03 Patient decision aids (PDAs) are evidence-based tools that PDAs help patients and clinicians work together to help patients to meaningfully make informed decisions based participate in decision-making on the clinically appropriate about healthcare options. Defini ning ng options, the best available charact ch cteristics cs scientific evidence, and what matters most to the patient. 01 01 02 02 PDAs make explicit the PDAs help patients to decisions that need to be clarify and communicate made, the options, and their values and their features. preferences.
11 traditional informed consent documents v. patient decision aids The informed consent process should work for you, not against you. Traditional informed consent documents are a source of waste in healthcare and are focused on clinician disclosure, not patient understanding. 1-3 Informed consent is a process , not a form. 4 Patient decision aids PDAs can help to make best practice, common practice Traditional informed consent document (ICD) Patient decision aid (PDA) Passive Active Signature on a form to conclude informed consent Interactive tool to prepare patients for informed consent conversations & facilitate shared decision-making One-way communication (clinician disclosure) Two-way communication (education and mutual understanding) Variability (depth, breadth & quality of content) Reliability (evidence-based; leverages deference to expertise) Content-oriented (type of information) Context-oriented (essential information applied to the relevant decision) Ineffective “ritualistic” formality 5 Evidence-based standards for ensuring quality 1 Pope TM. Informed Consent Requires Understanding: Complete Disclosure Is Not Enough. Am J Bioeth . 2019;19(5):27-28. 2 Ankuda CK, Block SD, Cooper Z, et al. Measuring critical deficits in shared decision making before elective surgery. Patient Educ Couns . 2014;94(3):328-333. 3 Brehaut JC, Carroll K, Elwyn G, et al. Elements of informed consent and decision quality were poorly correlated in informed consent documents. J Clin Epidemiol. 2015;68(12):1472-1480. 4 The Joint Commission. Informed consent: more than getting a signature. Quick Safety. http://www.jointcommission.org/issues/article.aspx. Published 2016. Accessed November 27, 2017; 5 Wear S. Informed Consent: Patient Autonomy and Clinician Beneficence within Healthcare. 2nd ed. Washington, DC: Georgetown University Press; 1998.
limitations of checklists & warnings Checklists Consider as a call for process reliability and decreased variation Checklist & box warnings do not: in information disclosure ✗ capture patient baseline understanding of concern(s) & available treatment options ✗ help to elicit patient goals, values & informed preferences Box warnings ✗ assess comprehension ✗ reconcile misunderstanding of information Recognizes a need for easily ✗ confirm a mutually [patient/clinician] agreed identifiable essential information upon treatment plan ✗ ensure compliance with national health literacy or numeracy guidelines, nor ✗ adhere to risk communication principles
shared decision-making & PDAs… improve : • patient knowledge about risks & benefits 1,2 • decision concordance with patient values 2 reduce : • decisional conflict 1,2 1. Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev . 2017;(4). doi:10.1002/14651858.CD001431.pub5 2. National Quality Forum (NQF). National Quality Partners Playbook TM : Shared Decision Making in Healthcare. 2018.
14 standards for developing & evaluating patient decision aids Minimum standards for screening and certification are published by the National Quality Forum (NQF). National Quality Forum (NQF). National Quality Partners Playbook TM : Shared Decision Making in Healthcare. 2018. pp 32-33.
15 standards for developing & evaluating patient decision aids screening criteria for PDA eligibility certification criteria 1. Describes the health condition or problem for which a 1. Provides a balanced presentation of options. decision is required. 2. Contains content based on a rigorous and documented evidence 2. Identifies the target user. synthesis method. 3. Explicitly states the decision under consideration. 3. Provides information about the evidence sources used. 4. Describes the options available for the decision, including 4. Provides key outcome probabilities, adopting risk communication nontreatment when appropriate. principles. 5. Describes the positive features of each option. 5. Provides a publication date. 6. Provides information about the update policy and next expected 6. Describes the negative features of each option. update. 7. Provides information about the funding sources used for 7. Clarifies patient values for outcomes of options by: development. b. asking patients to consider or rate which positive and 8. Provides information about competing interests and/or policy. negative features matter most to them; and/or 9. Provides information about the patient decision aid development c. describing the features of options to help patients process, including information about participation from target imagine the physical and/or social and/or users and health professionals. psychological effects. 10.Provides information about user testing with target patients and health professionals. 11.Reports readability levels. 12.Follows plain language guidelines, to ensure understanding of people with low literacy and/or low health literacy skills. Source: : National Quality Forum (NQF). National Quality Partners Playbook TM : Shared Decision Making in Healthcare. 2018. pp 32-33.
16 standards for developing & evaluating patient decision aids screening criteria for PDA eligibility certification criteria 1. Describes the health condition or problem for which a 1. Provides a balanced presentation of options. decision is required. 2. Contains content based on a rigorous and documented evidence 2. Identifies the target user. synthesis method. 3. Explicitly states the decision under consideration. 3. Provides information about the evidence sources used. 4. Describes the options available for the decision, including 4. Provides key outcome probabilities, adopting risk communication nontreatment when appropriate. principles. 5. Describes the positive features of each option. 5. Provides a publication date. 6. Provides information about the update policy and next expected 6. Describes the negative features of each option. update. 7. Provides information about the funding sources used for 7. Clarifies patient values for outcomes of options by: development. b. asking patients to consider or rate which positive and 8. Provides information about competing interests and/or policy. negative features matter most to them; and/or 9. Provides information about the patient decision aid development c. describing the features of options to help patients process, including information about participation from target imagine the physical and/or social and/or users and health professionals. psychological effects. 10.Provides information about user testing with target patients and health professionals. 11.Reports readability levels. 12.Follows plain language guidelines, to ensure understanding of people with low literacy and/or low health literacy skills. Source: : National Quality Forum (NQF). National Quality Partners Playbook TM : Shared Decision Making in Healthcare. 2018. pp 32-33.
17 standards for developing & evaluating patient decision aids Detailed criteria for evaluating the quality of PDAs is published by the International Patient Decision Aid Standards (IPDAS) Collaboration . International Patient Decision Aid Standards (IPDAS) Collaboration . IPDAS 2005: Criteria for Judging the Quality of Patient Decision Aids. http://ipdas.ohri.ca/IPDAS_checklist.pdf
18 A t to Z I Inventor ory of D Decis isio ion A Aids ds • Online database of * patient decision aids • Made publicly-available by the Ottawa Hospital Research Institute • PDA summary for Making quality decisions about primary breast augmentation surgery *PDA summary for Making quality decisions about primary breast augmentation surgery
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