1. Patient-centered dissemination of evidence-based medicine A Journey Toward Shared Decision Making

2. Encounter Research 3. Glasziou and Haynes ACP JC 2005 4. The body of evidence Systematic review of 115 RCTs Compared to usual care, decision aids: Increase patient involvement by 34% (+++-) Increase patient knowledge of options by 13% (++++) Increase consultation time by ~2.6 minutes Reduce decisional conflict by ~7% Reduce % undecided by 40% No consistent effect on choice, adherence, health outcomes or costs Stacey D et al. Cochrane review 2014 5. Examples Decision aid Evaluation Risk communication tools Statin Choice (primary care) Feasible, effective Independently validated Multicenter trial completed Implemented in EHR Chest pain Choice (emergency) Feasible, effective (Emergency) Multicenter trial seeking funding Aspirin Choice (primary care) Implemented in EHR without evaluation Osteoporosis Choice (primary care) Feasible, effective EHR implementation ongoing PCI Choice (cardiology) Ongoing AMI Choice (hospital) Feasible, effective (hospital) Issue cards DM2 Med Choice Feasible, effective Multicenter trial ongoing Implemented in EHR Depression Choice Ongoing 6. Weymiller et al. Arch Intern Med 2007 Statin Choice Web 7. Compared to usual care, patients using the decision aid were 22 times more likely to have an accurate sense of their baseline risk and risk reduction with statins. Weymiller et al. Arch Intern Med 2007 8. Osteoporosis Choice Montori et al, AJM 2011 9. AMI Choice 10. Chest Pain Choice Hess et al. Circ 2012 11. Mullan et al, Arch Intern Med 2009 Diabetes Medication Choice Video / Web 12. Depression Medication Choice LeBlanc 2012 13. Summary of Mayo experience Age: 40-92 (avg 65) Primary care, ED, hospital, specialty care 74-90% clinicians want to use tools again Adds ~3 minutes to consultation 60% fidelity without training 20% improvement in patient knowledge 17% improvement in patient involvement Variable clinical outcomes 14. Clinician decides how & when to use - and may elect not to use Considerations and What You Should Know cards are not given to patient as part of the comparison process Clinician and patient discuss the What You Should Know card. Patient selects a second card and compares the two. Clinician asks, What issues concerning a medication to treat depression symptoms would you like to discuss firs t ? Patient selects firs t card. Medication options are discussed. Patient and clinician review this card. Medication choice is made brochure given to patient to take home. a clinician guide to: Using the Depression Medication Choice Decision Aid (DA) with Patients 15. Statin Decision Aid 16. Web-based tool http://statindecisionaid.mayoclinic.org 17. Empathic decision making Partnership Dance across models Support deliberation 18. Incorporate research evidence and clinicians expertise into patient decisions 19. Conclusions It is feasible to promote evidence-based conversations during the clinical encounters with patients with chronic conditions. Decision aids designed for this purpose are efficient and effective in promoting shared decision making. Tools tested in randomized trials and proven effective are available for free. Partners to get to routine use in practice. 20. ShareEBM Patient-centered dissemination of evidence-based medicine http://www.share-ebm.org/ Mayo Clinic KER Unit (http://shareddecisions.mayoclinic.org) Institute for Clinical Systems Improvement (https://www.icsi.org/)