DEVELOPING A SHARED DECISION MAKING CURRICULUM

Angela Fagerlin, PhD

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.

Co-Director

Mary Politi, PhDAssistant ProfessorWashington UniversitySt. Louis, Missouri

Instructors

Dominick Frosch, PhD Karen Sepucha, PhD

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

Dominick Frosch, PhD

Introduction / Background Shared Decision Making

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

Angela Fagerlin, PhD

Psychology of Medical Decision Making

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

Mary Politi, PhD

Decision Support Interventions Development and Evaluation

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

Karen Sepucha, PhD

Decision Quality

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/

Interactive Activities

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

How Did Learners Like Us?

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

Course taught at New York University(2011 Currently)

Development of Decision Aids

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