Promoting Uptake of Shared Decision Making Approaches in Practice Annual Meeting Symposium PCORI Dissemination & Implementation Program November 2, 2018 #PCORI2018
PCORI’s Dissemination and Implementation Program • The D&I Program is charged with heightening awareness of the results of PCORI-funded research, and with advancing efforts to put these findings into practice to improve healthcare delivery and health outcomes. • From PCORI’s authorizing legislation: “The purpose of the Institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence…through research and evidence synthesis… … and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services...” 2
Why Shared Decision Making? • Even with good CER evidence, many important healthcare decisions are not clear cut. Often, several reasonable alternatives exist among the available treatment options. • In these instances, patients and their clinicians need to consider the options using the best evidence available, to support patients in making choices that reflect their values and preferences. • Shared decision making is widely recognized as a key component of patient-centered health care and an important decision making model in the context of uncertainty. 3
Shared Decision Making definition An intervention or approach that draws on and presents available evidence to inform patients of available treatment options and their risks and benefits, and either engages patients in a decision-making process that reflects their values with their clinician, or promotes their ability to engage in such a process. 4
Where are we with shared decision making? • SDM is effective • Systematic Reviews have established the positive effect of SDM approaches on patient knowledge, understanding of risks and benefits, and increased confidence in decisions • Increasing recognition of its importance in recent years • ACA language explicitly promotes SDM • Washington State legislation promotes SDM • National Quality Forum published certification standards (2016) based on international standards for patient decision aids/tools • CMS requires SDM as a precondition for payment for three treatment choices However…uptake of SDM in clinical practice remains relatively low 5
A focus on implementation of shared decision making approaches • “[D]espite these policy developments and the existence of over 80 randomized controlled trials that have demonstrated the efficacy of these interventions, their adoption into mainstream clinical practice has yet to be established, and their impact when used in routine workflows requires evaluation.” —Elwyn et al. 2013 • “Policy cannot replace the groundwork needed to ensure successful implementation. Common definitions, trusted certified decision aids, clinician engagement, strategies to enable seamless integration into practice , and a commitment to rigorous evaluation and improvement will be needed to achieve genuine shared decision making that is embraced by clinicians and the patients for whom they provide care and guidance.” —Spatz et al., 2017 6
Implementation of Shared Decision Making • The goals of PCORI support for the Implementation of Shared Decision Making are • To increase the uptake of shared decision making approaches in practice to improve patient-centeredness in health care. • To promote the communication and use of evidence – particularly evidence generated from PCORI-funded studies -- for supporting patients in making informed decisions about their care. 7
Today’s Presenters 11 AM Promoting Uptake of New Shared Decision Making Approaches moderator – Bill Lawrence MD, MS; PCORI • Erik Hess MD, MSc ; Patrick Dunn, PhD, MS, MBA, FAHA • Hazel Tapp PhD • Dan Matlock MD, MPH Break -- lunch available for pick up 12:30 PM Adapting Shared Decision Making Approaches • Glyn Elwyn MD, MSc, PhD, FRCGP • Chris Saigal MD, MPH • Discussant: Ralph Conwill 1:30 PM Roundtable – PCORI Funding Opportunities in D&I • PCORI D&I Program Staff: Michelle Henton MA; Bill Lawrence MD, MS; Arielle Gorstein MPH; Jane Chang MPH; Elizabeth Kang MSPH; Ethan Chang PhD; Kim Duong BS 8
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