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Online Tools Support Shared Decision-Making

September 10, 2013
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Thomas Jefferson University expanding use of online decision counseling

In a blog post last January, I wrote that I hoped we would see many more examples of innovation in patient engagement in 2013. Looking ahead to next year, I believe that Stages 2 and 3 of meaningful use should lay the foundation for more patient involvement in their own care teams, and it should move the industry toward giving patients the ability to electronically submit health information to providers.

Shared decision making is a burgeoning field involving a combination of personal interaction and digital technology. I was reminded of this by an invite to an upcoming conference in Boston. This year's Third Annual Shared Decision Making Summit, put on buy World Congress Sept. 19-20, will feature case studies of organizations that are enhancing outcomes with shared decision making.

Several of the presenters at the conference are from UPMC, an integrated health system in Pittsburgh. They will describe UPMC’s CHRIS patient engagement portal, which combines UPMC's cultural competency model with Let Us Help You (LUHU), a proactive care coordination model, and integrating both into its digital experience and data collection.

I noticed that one of the speakers at the conference was located here in Philadelphia, so I called him up. Prof. Ronald Myers, Ph.D., is director of the Division of Population Science in the Department of Medical Oncology at Thomas Jefferson University. He is leading an effort to use online decision counseling in a clinical setting.

Myers told me that healthcare is transitioning from a paternalistic to egalitarian framework. We are moving from physicians telling you that you should follow a prescribed treatment path toward making it a shared decision. The first step in empowering patients is providing decision aids, such as pamphlets or online presentations. They tend to increase patient knowledge, but they usually are one-way provisions of information to the patient, he said.

“The second part of the process is to elicit and understand how the person thinks and feels about the decision,” Myers said. “Our online decision counseling tries to elicit in choosing between option A and option B, what would influence or discourage you.”

These sessions are done in person or on the phone. The nurse or social worker tries to summarize patient answers in brief phrases and boil it down to the top three, and get the patient to rank them and rate them in terms of the level of influence on the decision.

The Jefferson team then enters those scores into the software application they have created that uses an algorithm to summarize their decision based on those top three factors they value the most.

All this information captured in a database can be linked in a report to the electronic health record, so that when they come in to see the physician next week, the physician has more information to talk to the patient about.

Myers said his team has had promising results in studies of patients with early, low-risk prostate cancer. After the shared decision making process, many more chose active surveillance vs. a more aggressive approach than national averages. “They reported that their knowledge increased and their anxiety decreased, and they felt that they had made a good decision,” he said.

Jefferson is now starting to move from research to rolling the system out gradually across the Jefferson campus — and perhaps beyond.

“We are speaking with clinical teams, looking for ideal opportunities to integrate it into routine care,” Myers said.  “We need to do more research and development on practice integration. Clinicians can order decision-counseling sessions for a patient, and they get something back in return. It is like ordering a test.”