Post on 22-Dec-2015
transcript
So Who Am I To Talk To You About Shared Decision Making Curriculum?
Co-Director of one shared decision making course at the Society of Medical Decision Making.
Will teach the SMDM course again this month as well as a 2nd course for researchers and clinicians at our Veterans Affairs hospitals/research centers.
I teach a 1week (40 hours) course on the development of decision aids.
Year 1: 4 Parts
Introduction / Overview of Shared Decision Making
Psychology of Medical Decision Making Heuristics and Biases Risk Communication
Decision Support Interventions Development Evaluation Implementation
Measuring a Quality Decision
Introduction / Background
Define patient engagement Relationship of SDM with evidence based
medicine Defining and relating equipoise to shared
decision making
Introduction / Background
Steps in shared decision making Identify situations in which SDM is critical Acknowledge decision to patient Describe options, including uncertainty Elicit / construct preferences and values Agree on a plan for the next steps
Benefits of shared decision making Patients Physicians
Heuristics & Biases
Availability Framing Anchoring and adjustment Default bias Omission and action biases
Risk Communication
Numeracy What it is, how bad it is, how crucial it is
Absolute vs. relative risk Frequencies vs. percentages Graph communication Baseline vs. incremental risk Less is more The importance of labels
Decision Support Interventions Development and Evaluation
What are decision support interventions (DESIs)? What have they been proven to do? Where is more research needed?
How are DESIs developed? How are DESIs evaluated? How are DESIs implemented?
Decision Support Interventions Development and Evaluation
Resources Development: http://decisionaid.ohri.ca/ http://ipdas.ohri.ca/
Evaluation http://ipdas.ohri.ca/ IPDASi:
http://www.ipdasi.org/IPDASi%20Information.pdf
Model of medical care Inputs / Process / Outputs
Research continuum: Patient decision aids Development Evaluation
Implementation Criteria for appraising survey
instruments Validity and reliability
Resources
OHRI common decision aid measures: https://decisionaid.ohri.ca/eval.html
• NCI-GEM SDM measures and reviews: www.gem- beta.org
• MGH decision quality instruments: http://www.massgeneral.org/decisionsciences/
• IPDAS chapter on evaluation (BMC) • CAHPS group (SDM requirement for
PCMH and ACOs): http://cahps.ahrq.gov/clinician_group/
2 Exercises
Evaluation of decision 3 groups—each received a different decision aid Used IPDAS (checklist) criteria to evaluate the
quality of the tool Evaluation of traditional research project vs. an
implementation project in routine care. Provided handouts that describe one of the two
research projects described above. Asked participants to reflect on
What is the goal of the project What are the most important outcomes/data to collect What are approaches/surveys that could assess
outcomes Strengths and weaknesses of different approaches
Our Evaluations
Pretty Well… Among the best courses I have ever taken: N = 1 A very good course w/ minor weaknesses: N = 8 A good course but significant room for
improvement: N = 1 A very weak course: N = 1 10 out of 11 would recommend this course to
colleagues Interactive involvement
Too little: N = 1 Just the right amount: N = 8 Too much: N = 2
Comments from Evaluations
Too many speakers Introduction too long Not enough on heuristics and biases Didn’t provide handouts Disagreement on the value of the
interactive exercises
Conclusions From Our First Attempt Our initial attempt was too ambitious
Tried to cover too much in too little time Needed to make sure people kept to the time
limit and that we were more thoughtful about how to focus/split up the content.
It might not be feasible to teach a truly comprehensive SDM curriculum in a short course setting. Too many subtopics, so little time.
Round 2: Upcoming Course
Will decrease: Number of speakers from 4 to 3 (but due to
maternity leave, only 2 will be there). Introduction Decision Quality
Increase Discussion of heuristics and biases that
affect medical decision making Discussion of how to decrease these biases
Change interactive exercises
Process Lecture & lab in the morning Lecture & lab in the afternoon Sharing of decision aid development challenges
Day 1 Background on models of patient-physician decision
making. What are decision aids? What they have been proven to
do, not do?
Day 2 Literacy Numeracy / Risk communication
Day 3 Preference elicitation Tailoring
Day 4 Web-based Decision Aids Implementation
Day 5 Survey design and evaluation Presentation of decision aids
One Last Resource Slide
Mary Politi teaches a course of shared decision making and shared this link to her course and syllabus: http://www.mphs.wustl.edu/Courses/MPHS%
20Elective#M19-560http://www.mphs.wustl.edu/Courses/MPHS%20Elective#M19-560
Paul Han (Risk Communication Module, designed for medical students) Han et al., Development and evaluation of a
risk communication curriculum. Patient Education and Counseling, 2014.
You Can’t Ask Me Questions (NOW)
But you can ask me later (or now, by email)fagerlin@med.umich.edu
@angiefagerlin
www.cbssm.med.umich.edu