Patient-centered dissemination of

evidence-based medicineA Journey Toward Shared Decision Making

Encounter Research

Weymiller et al. Arch Intern Med 2007

Statin Choice

Web

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

Osteoporosis Choice

Montori et al, AJM 2011

AMI Choice

Chest Pain Choice

Hess et al. Circ 2012

Mullan et al, Arch Intern Med 2009

Diabetes Medication Choice

Video / Web

Depression Medication Choice

LeBlanc 2012

ExamplesDecision 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

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

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

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.

ShareEBMPatient-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/)