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, PhD Assistant Professor Washington University St. Louis, Missouri Instructors Dominick Frosch, PhD
Karen Sepucha, PhD Year 1: 4 Parts Introduction / Overview of Shared Decision Making Psychology of Medical Decision Making Decision Support Interventions
Heuristics and Biases Risk Communication Development Evaluation Implementation Measuring a Quality Decision Introduction / Background Shared Decision Making Dominick Frosch, PhD
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 Psychology of Medical Decision Making Angela Fagerlin, PhD 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 Mary Politi, PhD 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%20Informa tion.pdf Decision Quality Karen Sepucha, PhD Model of medical care
Research continuum: Patient decision aids Inputs / Process / Outputs 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/decisionscie nces/
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 groupseach 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 Didnt 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: Increase
Number of speakers from 4 to 3 (but due to maternity leave, only 2 will be there). Introduction Decision Quality Discussion of heuristics and biases that affect medical decision making Discussion of how to decrease these biases Change interactive exercises Development of Decision Aids Course taught at New York University (2011 Currently)
Process Day 1 Lecture & lab in the morning
Lecture & lab in the afternoon Sharing of decision aid development challenges 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 Day 4 Preference elicitation Tailoring 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#M19560 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 Cant Ask Me Questions (NOW)
But you can ask me later (or now, by email) [email protected] edu @angiefagerlin www.cbssm.med.umic h.edu
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