Shared Decision Making in Practice
1. Integrating patient decision aids into routine care
Clinicians at Massachusetts General Hospital (MGH) are able to order patient decision aids (PtDAs) through the electronic medical record for a variety of health topics including cardiology, mental health, women’s health, orthopedics, men’s health and geriatrics. The PtDA prescription may be ordered in a web-based or print format. It is documented in the patient’s chart and the order is fulfilled by staff at the Health Decision Sciences Center.
There are a variety of processes for prescribing the decision aid.
- A common approach is for the clinician to order the decision aid during a visit with a patient after discussing the topic. A follow-up appointment is scheduled if necessary.
- We have engaged patients in self-ordering decision aids prior to their upcoming appointment. There was a significant increase in the use of the tools as well as a change in the ordering pattern. Patients ordered programs on chronic symptomatic conditions (e.g. insomnia and anxiety) at a higher rate than did physicians, who ordered more programs on cancer screening options and advance directives planning.
- To create a more reliable process for delivering decision aids, the decision aid orders were linked to a referral. The referral to a specialist often marks a “decision point” in patients’ care. Allowing clinicians to provisionally prescribe a decision aid prior to the patients’ consultation appointment sets the stage for shared decision making in the preference-sensitive treatment decision.
2. Training and Education in shared decision making
a. Clinician Training:
Training in effective communication skills and risk communication include core concepts of shared decision making.
- Clinical practice lunchtime workshops
- Annually, HDSC hosts workshops with primary care clinical practices. These workshops enhance shared decision-making conversations by promoting use of decision aids, providing site-specific updates, introducing new available tools, and discussing best practices for implementation.
- Medical resident ambulatory curriculum workshops
- Teaching workshops are held with internal medicine residents during a rotating block in their curriculum. These workshops define shared decision making and its role in routine care, introduce tools that are available at MGH to facilitate shared decision making in clinical practice, discuss cases relevant to everyday practice, and how the tools may assist to improve clinical conversations and decision making.
- Quality Improvement (QI) projects
- QI projects have been conducted to create awareness and introduce concepts of shared decision making.
- Many departments have set targets for QI measures around the implementation of shared decision making.
b. Patient Education:
- The HDSC hosts monthly lunchtime educational sessions for patients, staff, and the general public. These programs aid in engaging patients in their healthcare. These sessions allow for the viewing of a particular decision aid followed by a facilitated discussion with a clinician whose academic focus is within that particular health topic.