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Shared Decision-Making Picks Up Steam at UCLA

August 25, 2014
by Rajiv Leventhal
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Patient-education tools such as online surveys and videos have helped clinicians at UCLA take on shared decision-making in various treatment areas, according to the university.

Shared decision-making is a concept that’s gaining traction in medicine, particularly in areas of healthcare, where patients are presented with more than one reasonable treatment option. The programs, which feature patient-education tools such as online surveys and videos, have several goals, according to a UCLA news release.

One is to help people thoroughly understand their choices and assure them that they are making informed decisions. Another major objective is to curb healthcare costs by sometimes steering people away from expensive treatments that are unlikely to result in better health or improved patient satisfaction.

UCLA’s Department of Urology began offering a shared decision-making tool for men with prostate cancer in 2013. Department staff plug in data about the patient’s diagnosis, such as the “aggressiveness” score of the tumor, test results, age, race and other medical conditions—all things that could affect the treatment decision. After the patient completes a 15-minute survey regarding his preferences, the resulting report is sent to the doctor ahead of the scheduled consultation, during which the physician and patient meet to discuss the options.

An even-more-elaborate shared decision-making program is underway at UCLA for patients with painful chronic conditions, such as hip or knee arthritis, spinal stenosis or herniated disc. UCLA is one of 20 participants in a national study on shared decision-making called the High Value Healthcare Collaborative. Funded by the national Centers for Medicare and Medicaid Services (CMS) and led by the research team at Dartmouth, the study is a rigorous test of the potential benefits of shared decision-making.

Study participants watch a video that was produced for the study. The video depicts actual patients who discuss their condition and how they arrived at their various choices. The video describes treatment options and the pros and cons of each. After watching the video, patients participate in a 45-minute-telephone or in-person discussion with a health coach who helps them distill the information.

After the session, the health coach enters notes in the patient’s file to inform the physician of which treatment option the patient is leaning toward. But no decision is made until the doctor and patient confer.

Ultimately, shared decision-making cuts through biases and crystallizes important issues for both doctor and patient, said Dr. Christopher Saigal, M.D., vice chair of urology at UCLA.  “Shared decision-making improves the decision-making processes for both parties,” he said in the news release. “It is a collaboration. The idea is not that the patient tells the doctor what to do — the doctor does have expertise and an opinion that has to be heard by the patient—but the patient is in charge of the decision. It’s his body.”

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