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For Immediate Release: Contact:
Vicky Jaffe Better Informed Patients Opt for Less Surgery When Choosing Treatment Options When Medicare patients face treatment choices about discretionary surgery, the patients should get unbiased, complete information that allows them to make an informed choice about which treatment option they prefer, according to a November/December 2007 Health Affairs article. John E. Wennberg and co-authors Annette O’Connor, E. Dale Collins and James Weinstein, all of the Dartmouth Institute for Health Policy and Clinical Practice, urge the Centers for Medicare and Medicaid Services (CMS) to lead in establishing informed patient choice as the standard for determining medical necessity for discretionary surgery. The authors cite the example of early stage breast cancer, for which mastectomy or lumpectomy followed by radiation yield similar mortality outcomes. “Many women have strong preferences for one or the other, so quality of care extends beyond the surgeon’s technical skills to the decision-making process.” In these discretionary cases, the patient should engage in a process known as shared decision making, augmented by patient decision aids, to work with their physician to achieve informed patient choice. Shared decision making helps patients become fully informed about their illness, understand the likely outcomes of various options, think about what is personally important about the risks and benefits of each option and participate in decisions about medical care. The decision aids are tools – in formats such as DVDs and pamphlets – that explain fairly and clearly the pros and cons of each option. Pointing to research that shows that informed patients are less likely to opt for surgery despite what might be a doctor’s initial recommendation, the authors state, “There is growing evidence that the amount of surgery that can be justified on the basis of traditional practice guidelines actually exceeds the amount of surgery that patients want when fully informed.” For that reason, the authors urge Medicare to launch a pilot program to determine the best way to implement shared decision making nationally, followed by a pay-for-performance program that rewards hospitals and surgery centers that make informed patient choice the standard for medical necessity, and that eventually cuts off those who do not. The authors note that there are potential economic benefits to Medicare. “Although the argument for informed patient choice is based on ethical principles of patient autonomy, the clinical trial data suggest that implementing high-quality shared decision making could also result in Medicare savings via a drop in utilization. The impact on the overall use and cost of medical care, however, needs to be measured over the longer term, with careful monitoring of outcomes.” The article, entitled, “Extending the P4P Agenda, Part 1: How Medicare Can Improve Patient Decision Making and Reduce Unnecessary Care,” is in the current November-December 2007 issue of Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/26/6/1564 About the Authors About the Foundation for Informed Medical Decision Making ^ Top  For Immediate Release: Contact:
Vicky Jaffe Boston, MA October 2, 2007 – The Foundation for Informed Medical Decision-Making announces seven investigator-initiated grant awards up to $100,000 each, to support research at universities throughout the world that advances the field of shared decision making in medical care. “The Foundation believes strongly in supporting university investigator-initiated research to improve the informed medical decision making process for patients with a variety of healthcare conditions,” said Jack Fowler, president of the Foundation for Informed Medical Decision Making. “Today’s patients face a complex array of treatment, prevention and screening options, so the better informed they are about their various choices, the greater chance they have of getting the healthcare that’s right for them.” U.S. Research Grants University of California Los Angeles (UCLA) researchers Dominic Frosch, PhD and Carol Mangione, MD, MSPH are studying how to activate seniors to improve chronic disease care. Chronic diseases are the primary cause of morbidity and mortality for older Americans. Active patient participation in treatment decision-making has the potential to significantly improve outcomes in chronic disease care, but interventions to increase participation remain underused. This study targets adults in senior centers using a randomized encouragement design to test the effectiveness of a modest financial incentive on increasing seniors’ participation in group screenings. They will evaluate the effects of the intervention on seniors’ decision making role preferences, attitudes, perceived social norms and self efficacy for asking questions of their physician, health-related quality of life, physical activity, and changes in prescribed treatment regimens and self-care. Researchers at Johns Hopkins School of Medicine in Baltimore, MD are studying the quality of decision making communication and outcomes of care for African Americans with depression. Lisa Cooper, MD, MPH and Gail Daumit, MD, MHS will examine the quality of shared decision-making communication between primary care providers and African American patients with depression. Studies have revealed racial differences in patient attitudes and patient-provider communication, and it has been suggested that these factors play a role in mental healthcare disparities, but little empirical work has tested this assumption or identified particular patient or provider behaviors for future intervention. This study looks to increase understanding of the role of shared decision making in improving outcomes for patients with depression and in reducing racial disparities in mental health care. James Dolan, MD and Peter Veazie, PhD of the University of Rochester are studying the effectiveness of patient decision aids based on the “Consumer’s guide to choosing pain medicine for osteoarthritis,” recently published by the Agency for Health Care Research and Quality (AHRQ). A major objective of the study is to prepare for a subsequent comparative clinical trial. The study will proceed in five phases. In Phase one, the researchers will determine what information the decision aid should contain. In Phase two, they will develop a prototype, and in Phase three, will conduct a series of small focus group sessions to test the prototype and make revisions as necessary. Phase four will test the prototype decision aid's clarity and ease of use in a sample of 40 patients with osteoarthritis pain. Phase five will be devoted to summarizing and disseminating the study results. At Seattle’s Group Health Center for Health Studies, David Arterburn, MD, MPH, Stephen Bock, MD, Onchee Yu, MS, Emily Westbrook, BA, and Daniel Cherkin, PhD are conducting a randomized controlled trial of the Foundation for Informed Medical Decision Making’s Patient Decision Aid for bariatric surgery. Bariatric (weight loss) surgical procedures have been shown to significantly improve the health and quality of life of morbidly obese adults; however, there are also substantial risks associated with this surgery. Thus, a morbidly obese patient’s decision regarding bariatric surgery should be based on his or her evaluation of accurate information on the possible risks and benefits of the various treatment options. Anecdotal reports suggest that bariatric treatment decisions may be more heavily influenced by insurance coverage and reimbursement rates than patient preferences. The main objective of this research is to examine the impact of the decision aid, Weight loss surgery: Is it right for you? on decision quality in primary care and specialty practice settings. The researchers will assess the effect of this decision aid on bariatric-specific measures of patient knowledge, values, and choice of weight management strategy. International Research GrantsUniversity of Ottawa researchers Dawn Stacey, PhD, Gillian Hawker MD, MSc, and Annette O'Connor, RN, PhD are evaluating the effectiveness of patient decision aids for total joint replacement, looking at whether they are cost-effective and optimize the surgical referral process from primary care. Among clinically appropriate candidates for hip/knee total joint arthroplasty (TJA), patients’ surgical preferences are low and strongly associated with misperceptions. This study uses a randomized controlled trial of 290 patients referred for hip/knee TJA to examine whether patient decision aids, combined with surgical eligibility screening, will improve misperceptions and optimize the referral process because eligible candidates may make informed choices to forgo surgery. University of Sydney Australia researchers Alexandra Barratt, PhD, Martin Tattersall, PhD, Lyndal Trevena, MD and Phyllis Butow, PhD are testing the effect of consumer questions on prompting clinicians to discuss and apply evidence to the care of an individual patient within a randomized trial using standardized patients. Other studies have tested the effect of preparing patients to ask questions to address their information needs with respect to a particular condition (most often cancer), but this study will be the first to test the effect of consumers asking questions specifically designed to prompt physicians to discuss and apply evidence to them as individuals, and as such, it tests a simple intervention to increase evidence-based, shared decision making. While consumer questions may represent an effective way to increase evidence-based practice and shared decision making, they need evaluation to identify their effects on care, and clinical processes (such as length of consultation). This work is being undertaken in both primary care and specialist care, with results expected to be broadly applicable to international health care delivery. At the Max Planck Institute in Berlin, Germany, Mirta Galestic, PhD, Wolfgang Gaissmair, PhD, and Gerd Gigerenzer, PhD are researching how to help people with low numeracy to better understand medical information. Informed medical decision making depends critically on communication of quantitative medical data. People with low numeracy skills may have particular problems with understanding such data correctly. Building on previous research showing that problems with understanding numeric information often do not reside in the mind, but in the representation of the problem, the researchers are investigating five presentation formats that might be particularly suitable for people with lower numeracy skills. These formats are: relating very large numbers to examples from everyday life, using analogies to explain predictive accuracy of medical screenings, making consequences of risky behaviors more tangible, using icon displays to explain risks and risk reductions, and using evolutionary plausible group sizes as risk denominators. The formats will be examined within Web-based experiments on probabilistic samples, and results will be contrasted for people with low vs. high numeracy skills. To examine cross-cultural effectiveness of the formats, the investigators will compare the results from two countries with different medical systems and different traditions in risk communication: the United States and Germany.
^ Top For Immediate Release: Contact:
Vicky Jaffe Local Winners study at Harvard School of Public Health and Boston VA Research Institute Boston, MA September 25, 2007 – The Foundation for Informed Medical Decision Making announced this year’s six $25,000 George Bennett Dissertation Fellowship winners. The awards will support dissertation and post doctoral research to better understand and improve patient/doctor communication. Dissertation topics include testing how anxiety affects decision-making and the effect of video images, testimonials or discussions. The grants are designed to support basic and applied research that advances the field of informed decision making, which helps patients make better, more informed health care choices connected to their individual values. “These grants are intended to encourage young researchers to pursue interests related to helping patients be informed and actively involved in decisions that affect their health and well being,” said Jack Fowler, president of the Foundation for Informed Medical Decision Making. “We had a strong set of applications, and we are very pleased to be able to fund these projects.” The fellowship is named for George Bennett, founder and CEO of Health Dialog, a leading provider of care management and analytic services dedicated to a patient centered approach to support informed medical decision making. Each award provides $25,000 to be paid through each fellow's school, and may be used to cover living expenses, travel, tuition support, or research expenses. 2007 award winners include: Angelo Volandes, MD, M.P.H., a Ph.D candidate at the Harvard School of Public Health is conducting a randomized trial studying Advance Care Planning for elderly patients using a video depiction of a patient with dementia compared to the traditional verbal narrative. Angelo is from New York City and received his undergraduate degree from Harvard University. He is also a faculty member at Harvard Medical School and Massachusetts General Hospital. Erin Winters Ulloa, Ph.D at Boston VA Research Institute, is examining how functional health literacy (a patients’ ability to read, understand, and effectively utilize basic health information) and cancer-related anxiety affect men’s decision making about treatment for prostate cancer. Results from the project will be used to support and develop interventions to improve decision making for men with localized prostate cancer by addressing the variables studied in this proposal: functional health literacy and cancer-related anxiety. Erin is from New Brunswick, NJ and received her undergraduate degree from James Madison University and her Masters and Ph.D in Clinical Psychology from University of South Florida. Gabriel Karl Silverman, originally from Floral Park, Queens, New York is a Ph.D candidate in Social and Decision Sciences at Carnegie Mellon University, is examining whether physician communication about end-of-life issues with patients and their caregivers can lead to "good deaths" and better bereavement adjustment, if those discussions happen early enough, often enough, are clear, and allow questions. Gabriel received his undergraduate degree from Yale University. Talya Salz is a Ph.D candidate at the University of North Carolina Chapel Hill, whose research is part of the national Cancer Care Outcomes Research and Surveillance study of colorectal cancer (CRC) survivors. She is examining the underuse and overuse of colonoscopies to improve informed decision making about colonoscopy use among CRC survivors. Talya is originally from Longmeadow, MA and received her undergraduate degree from Brown University. Amanda Dillard, Ph.D, from Tiffin, OH is working on post-doctoral research at the University of Michigan to study the effect of patient testimonials to improve the accuracy of cancer risk perceptions among colon cancer patients. Amanda received her Ph.D from North Dakota State University. About Foundation for Informed Medical Decision Making ^ Top For Immediate Release: Contact: Vicky Jaffe Bill Acknowledges Value of Decision Aids in Improved Patient Outcomes (Seattle, WA) Governor Christine Gregoire is set to sign legislation today that will make Washington the first state to endorse the benefit of doctors and patients using a process called "shared decision making" when confronted with important treatment choices. Passage of ESSB 5930 represents the first acknowledgment by a state legislature that there is growing evidence that medical outcomes can be improved by patient-practitioner communication enhanced by high-quality decision aids. In addition, the legislation demonstrates Washington's commitment to improving patients' ability to make informed medical decisions by formally recognizing shared decision making in the state's laws on informed consent and encouraging collaborative efforts to develop, certify, use and evaluate decision aids. Shared decision making is a process by which the physician shares with the patient all relevant risk and benefit information on all treatment alternatives, and the patient shares with the physician all relevant personal information that might make one treatment or side effect more or less tolerable than others. Numerous studies indicate that when decision aids (such as brochures, DVDs or online tools) are available to patients and they have the opportunity to participate in medical decision making with their physician, the patient-physician dialogue improves, and patient well-being improves as well. "The main priority of the Washington State Medical Association is to make Washington a better place to practice medicine and to receive care. Shared decision making is one step towards accomplishing that goal by building upon the valued physician/patient relationship," said Hugh Maloney, MD, president of the Washington State Medical Association. "Such common sense legislation puts into practice a concept that is realistic, practical and helps physicians serve our patients and our profession, as we seek the highest standards of medical care." Dr. Maloney added. The provisions are part of a larger health reform package contained in ESSB 5930, entitled "Providing high quality, affordable health care to Washingtonians based on recommendations of the blue ribbon commission on health care costs and access." "The Legislature has learned that when patients are better
informed about treatment options, they make decisions that are more
aligned with their personal preferences, rather than opting for
the most invasive or expensive procedure," said state Sen.
Cheryl Pflug, Republican Deputy Leader and prime sponsor of the
shared decision making bill, which was later rolled into the omnibus
bill. "We will improve health care while at the same time managing
our fiscal resources by The bill enables the state Health Care Authority (HCA) to implement a shared decision making demonstration project in partnership with multi-specialty group practices. HCA provides access to high-quality health care for more than 500,000 Washington residents through its administration of health care programs, including public employees' health coverage and Basic Health, a coverage program for low-income working families. The demonstration project will incorporate decision aids into clinical practice to assess their effect on health care quality, cost and patient satisfaction. "At Group Health, we know that patients are happier with their care and outcomes when they fully understand all of their treatment options," said Hugh Straley, M.D., medical director of Group Health Cooperative and president of Group Health Permanente. "With shared decision making, patients weigh the risks and benefits of the options along with their own values and needs, arriving at the right answer for them. Often, the right care from the patient's perspective also costs less. This legislation is about giving physicians and patients the tools and skills they need to be more effective partners in care in the real world of a busy, complex health care practice." ESSB 5930 also requires HCA to create the Washington State Quality Forum, in collaboration with Puget Sound Health Alliance, to collect research and health care quality data. "This legislation is groundbreaking and empowers patients with relevant medical information to enable them to make treatment decisions based on their individual preferences," said John E. Wennberg, M.D., M.P.H, co-founder, senior policy advisor, Foundation for Informed Medical Decision Making. He is also Principal Investigator for the Dartmouth Atlas Project (www.dartmouthatlas.org), which documents dramatic geographic differences in the cost and quality of U.S. health care. For treatment decisions regarding preference-sensitive care, where there are competing choices and doctors and patients must make discretionary decisions for conditions such as prostate cancer, breast cancer or lower back pain, individual patient input is paramount. This is where the standard of shared decision making vs. informed consent comes into play to improve patient satisfaction and outcomes. Beyond improving patient outcomes, the use of patient decision aids provides legal protection for doctors, i.e., if a competent patient signs an acknowledgement of shared decision making, it constitutes evidence that the patient has given his or her informed consent, that can only be rebutted by "clear and convincing evidence." This is a higher standard of defense for a physician than the "preponderance of the evidence" standard that currently exists for doctors who use informed consent forms. Shared decision making is currently being incorporated across the United States, at academic medical centers, including the Dartmouth Hitchcock Medical Center in New Hampshire, Massachusetts General Hospital, University of Arizona Cancer Center, University of California (L.A., San Diego and San Francisco), University of Cincinnati and the University of North Carolina. For more information on shared medical decision making, visit www.fimdm.org.
FIMDM is a non-profit organization dedicated to assuring that people
understand their choices and have the information they need to make
sound decisions affecting their health and well being. ^ Top
HealthNewsReview.org Publisher to
Present Data at AHCJ Conference Contact: Vicky Jaffe Los Angeles, CA., March 14, 2007 – After reviewing more than 300 health care news stories, the Publisher of HealthNewsReview.org (http://healthnewsreview.org) reports that only 26 percent satisfactorily discuss the costs of health care products and procedures, fewer than 30 percent explain potential benefits adequately, and fewer than 35 percent adequately describe potential harms. “With health care spending now making up 16 percent of the U.S. gross domestic product, good journalism should not exclude information about costs when reporting about treatments or procedures,” says Gary Schwitzer, HealthNewsReview.org editor and professor at University of Minnesota School of Journalism & Mass Communication. “But if you don’t discuss costs while also failing to adequately explain the best information on possible benefits and harms, you are presenting an imbalanced and incomplete picture of products and technologies for American consumers.” In his Mar. 16th 9:30 a.m. presentation at Health Journalism 2007, Association of Health Care Journalists (AHCJ) Conference at the Hilton Los Angeles/Universal City, Schwitzer will describe and examine trends in coverage that both affect the quality of information consumers receive, and reflect on the state of today’s healthcare journalism. While some of the findings are troubling, the project has also found some shining examples of excellent health journalism, including more than 20 that received the site’s highest “five-star” rating. While some health journalists complain that they can’t get all the vital information into a story limited by word or space caps, the site has identified several excellent stories that were written in only about 500 words. HealthNewsReview.org was launched in April 2006 in collaboration with the Foundation for Informed Medical Decision Making (FIMDM). It is the first U.S. online service designed for journalists and consumers who want reliable, unbiased analysis and evaluation of news stories that make claims about treatments and procedures. It is the largest such dynamic database of content analysis of U.S. health news coverage and it is growing by the day. Each story is analyzed by three different reviewers, coming from a team of more than 20 highly qualified professionals with expertise in journalism, medicine, public health and health services research. News stories are culled from the top 50 circulation newspapers, major broadcast media, weekly news magazines, and wire services.
About Professor Gary Schwitzer Professor Gary Schwitzer specialized in healthcare journalism in his more than quarter-century career in radio, television, interactive multimedia and the Internet. He is a member of the faculty of the School of Journalism & Mass Communication at the University of Minnesota, and is Director of Graduate Studies for the School's M.A. in Health Journalism program. For 15 years he was a daily health journalism beat reporter. He has served two terms as a member of the board of directors of the Association of Healthcare Journalists, and is a member of the Society of Professional Journalists and the Broadcast Education Association.
The Foundation for Informed Medical Decision Making’s mission is to assure that people understand their choices and have the information they need to make sound decisions affecting their health and well being. The Foundation organizes and frames medical evidence in an unbiased manner to help people evaluate their options, particularly in instances where differences in individual preferences and perspectives are likely to affect personal choice. For more information, visit http://www.fimdm.org. ^ Top
For Immediate Release: June 1, 2006 Contact: George Bennett Dissertation Fellowships Awarded to Doctoral Students Across North America Local Winners include Ipswich, MA Native and Harvard University Grad. Student “Ideally, the patient and his or her doctor are partners in medical decision-making,” said Jack Fowler, president of the Foundation for Informed Medical Decision Making. “The work that this year’s fellowship winners are undertaking will help future patients make better, more informed choices connected to their individual values.” Award-winner Melissa Constantine, an Ipswich, MA native, is a Ph.D. candidate at the University of Minnesota’s School of Public Health, Division of Health Services Research & Policy. Her dissertation, “The Effect of Institutionalization of Medical Care on Quality of Patient’s Informed Consent,” evaluates how well-informed a patient is before given the Quad Test, which is administered to pregnant women to determine if there are chromosomal abnormalities. Ms. Constantine is working to determine the association between the process of obtaining informed consent and the three elements of informed consent: intentionality, understanding and freedom from a controlling influence. Constantine completed her undergraduate work at the University of Massachusetts in Boston with a Bachelor of Arts Degree in Science, Technology & Values. Rebecca Anhang Price is a Health Policy Ph.D. candidate on the Medical Sociology track at Harvard University’s Graduate School of Arts and Sciences. She is originally from Winnipeg, Manitoba where she graduated from Joseph Wolinsky Collegiate High School. Her research assesses the effects of a direct-to-consumer advertising campaign for a cervical cancer screening test. It will evaluate the association between campaign exposure and decision-making processes, patient satisfaction and the clinical appropriateness of test use. Price completed her undergraduate work at the University of Pennsylvania with a BA in Communications, followed by her Masters in Health Policy & Management at Harvard School of Public Health. Mary Ann Murray is on the Health Sciences faculty at the University of Ottawa’s School of Nursing. She is originally from Ottawa where she graduated from Sir John MacDonald High School. Her dissertation is “Efficacy of a Training Intervention on the Quality of Nurses’ Decision Support for Patients Deciding About the Place of Care at the End of Life: A randomized Control Trial.” The aim of this project is to determine whether the quality of nurses’ decision support can be improved with a theory-based skills building intervention. Murray has a Bachelors and Masters Degree in Nursing from the University of Ottawa. Daniel Menchik is pursuing his doctorate at the University of Chicago’s Department of Sociology. Originally from Okemos, Michigan, where he graduated from Okemos High School, Mr. Menchik’s research will try to identify the strategies used by patients that enable successful input into their treatments and indicate the conditions under which physician decisions are influenced by colleagues or scientific research. Menchik also graduated from the University of Wisconsin at Madison with a Bachelors Degree in Political Science and Journalism. He then earned his Masters in Philosophy at the University of Cambridge and a Masters in Sociology from the University of Chicago. The George Bennett Dissertation Fellowship program supports dissertation research in shared medical decision-making. The grants are designed to support basic and applied research that can advance the field, and to attract scholars to the field of shared decision-making in medical care. Applicants must have completed all required coursework toward the doctorate. The dissertation proposal must have been approved by the time of funding. Each award will provide $25,000 to be paid through each fellow's school. Fellows may use stipends to cover living expenses, travel, tuition support, or research expenses.
Contacts: Mark Cassutt Sandy Dawkins Web Site Launched to Evaluate Health News Reporting in Mainstream U.S. Media HealthNewsReview.org gives Journalists, Consumers Unbiased Review of News Articles that Cover New Treatments, Procedures
The site uses various criteria to rate stories, including:
“It could be very helpful for every editor to have a list
of these criteria on his or her desk,”
Professor Gary Schwitzer has specialized in healthcare journalism in his more than quarter-century career in radio, television, interactive multimedia and the Internet. He joined the faculty of the School of Journalism and Mass Communication at the University of Minnesota in the Fall of 2001. He is Director of Graduate Studies for the School's M.A. in Health Journalism program. Gary came to the UMN after being the founding Editor-In-Chief of the MayoClinic.com consumer health Web site. He has served two terms as a member of the board of directors of the Association of Healthcare Journalists, and is a member of the Society of Professional Journalists and the Broadcast Education Association.
The Foundation for Informed Medical Decision Making’s mission
is to assure that people understand their choices and have the information
they need to make sound decisions affecting their health and well
being. The Foundation organizes and frames medical evidence in an
unbiased manner to help people evaluate their options, particularly
in instances where differences in individual preferences and perspectives
are likely to affect personal choice. For more information, visit
http://www.fimdm.org. ^ Top
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Press Releases - Leading Researchers Identify Methods for Medicare to Improve Patient Care and Reduce Costs Using Shared Decision Making - Grants Awarded to Investigators Worldwide to Advance Patient Decision Making - Informed Medical Decision Making Fellowships Awarded to Support Research to Improve Patient and Doctor Communication - Washington Becomes First State to Endorse Shared Medical Decision Making - Health News Stories Usually Ignore Complete Information - George Bennett Fellowship awards - HealthNewsReview In the News |
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