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Tools for helping patients make informed decisions

Since Massachusetts General Hospital established one of the first shared decision-making programs in the country in 2005, it has been a leader in promoting the routine use of patient decision aids to facilitate quality communication between patients and providers.

Today, clinicians and patients across Mass General Brigham are increasingly relying on more than 150 available shared decision aids to improve the quality of their conversations about significant medical decisions.

“These step-by-step tools help patients to understand their choices, compare risks and benefits and express their preferences and personal values in order to decide what is right for them,” says Karen Sepucha, PhD, director of the Health Decision Sciences Center in the Division of General Internal Medicine at Massachusetts General Hospital and an associate professor in Medicine at Harvard Medical School. Most frequently, they are used by patients considering a surgical procedure, but there also are decision aids for patients considering options for management of chronic conditions, cancer screening tests or birth options after a cesarean section.

Research, conducted from over 105 randomized trials across 50 different conditions and involving 31,000 patients, supports the idea that decision aids help patients to better understand their options, both good and bad, says Dr. Sepucha. Studies have also found that these tools significantly improve knowledge and involvement of patients who may have access to fewer resources because of their race, ethnicity, language or socioeconomic status.

“What I like about using the shared decision aids is they provide an opportunity to discuss points a patient may not have brought up otherwise,” says Antonia Chen, MD, MBA, director of Research, Arthroplasty Services at Brigham and Women’s Hospital and an associate professor of Orthopaedic Surgery at Harvard Medical School. “A shared decision-making aid may enable patients to ask more questions, indicating that patients are better informed, and we are able to have deeper discussions.”

When a tool is completed online through the patient portal, a summary is added to the patient’s medical chart to be available for future conversations, and as a reference for the patient. These enhanced online shared decision aids are currently available in English and Spanish. Print format decision aids are available in English, Spanish, Portuguese, Haitian Creole, Russian, Traditional Chinese and Arabic.

Primary care and specialty care providers and their staff may order decision aids for a patient via Epic. Patients using Patient Gateway may access the decision aids there.

To help with the ordering process, the Health Decision Sciences Center has created a tip sheet and a demonstration video. To view the various decision aids available online, visit this link. If you have questions about the decision aids, email decisions@partners.org.

Karen Sepucha, Lynn Vavreck, the Marvin Hoffenberg Professor of American Politics and Public Policy at U.C.L.A., along with Arash Naeim, Neil Wenger and Annette Stanton at the David Geffen School of Medicine at U.C.L.A. found that two strong incentives to motivate the unvaccinated, dependent on their political party affiliation. In a randomized survey experiment, a cash reward would make them more likely to get a shot if they identified as a democrat and if they didn’t need to wear a mask or social-distance in public once vaccinated they would more likely get a shot if they identified as a Republican. This work was featured in The New York Times here.

Recently, our medical director Dr. Leigh Simmons spoke with the Lown Institute about how the COVID-19 pandemic has changed care delivery.

You can watch the interview on the Lown Institute website or by clicking on the video below.

A journal summary of Dr. Karen Sepucha’s publication in The Journal of Bone and Joint Surgery about decision support strategies for hip and knee osteoarthritis (DECIDE-OA study) was recently published in Advances in Motion. The article can be found at the following link.

Press Release

Karen Sepucha, PhD and Leigh Simmons, MD Approved for $2.2 Million in Research Funding for Promoting Informed Decisions about Cancer Screening in Older Adults (PRIMED Study)

Funds awarded by the Patient-Centered Outcomes Research Institute

Drs. Sepucha and Simmons from the Health Decision Sciences Center (HDSC) at Massachusetts General Hospital have been approved for a $2.2 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to address an important gap in our understanding of how to support clinicians and older patients in making good decisions about whether to continue colorectal cancer (CRC) screening. The study, Promoting Informed Decisions about Cancer Screening in Older Adults (PRIMED Study), will advance our understanding of how to best communicate evidence of cancer screening benefits and harms to older adults and is well aligned with PCORI’s mission.

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Earlier this month, NQF published the NQP Playbook™: Shared Decision Making in Healthcare, which was developed with input from Dr. Sepucha and other experts in the field. The playbook has guidance for institutions looking to implement shared decision making and culminates important work by the NQF to recognize and promote SDM as a key tenet of improving healthcare quality. The playbook can be purchased here.

Massachusetts Health Quality Partners featured the work of the HDSC as a key strategy to increase patient engagement at Partners HealthCare.

Dr. Barry is quoted in a WBUR piece about the role of shared decision making and active surveillance in breast cancer treatment. WBUR is covering the changing face of cancer their series This Moment in Cancer.

Dr. Barry weighs in on family decision making about prostate cancer screening and treatment. Read the WBUR piece here.