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The Foundation for Informed Medical Decision Making works with health care delivery sites around the country to foster the implementation of shared decision making. Some of these sites now have experience and knowledge to illustrate several models of care that recognize patient preferences as an integral part of medical practice. In this section, we highlight the work of these sites.
DHMC Spine Center
At the Dartmouth Hitchcock Medical Center Spine Center,
shared decision making has become an integral part of the patient centered approach to spine care. All patients facing a surgical decision as well as those in the Functional Restoration Program have access to patient decision support information prior to making any decisions about care and treatment.
Shared Decision-Making® Programs Available:
 Treatment Choices for Spinal Stenosis
Treatment Choices for Herniated Disc
Chronic Low Back Pain: Managing Your Pain and Your Life
Acute Low Back Pain: Managing Your Pain Through Self-Care
These programs help patients
Evaluate treatment options and possible outcomes
Think about what is important to them
Participate in the decision process with their health care providers
In addition to establishing shared decision making as a standard of patient care, the Spine Center at Dartmouth Hitchcock Medical School serves as a lab for the Foundation to review and develop it’s portfolio of back and spine care Shared Decision-Making programs.
Through the DHMC Center for Shared Decision Making, patient feedback is collected to establish what facts and values patients feel are important to making a decision about treatment for their spine conditions. These facts and values are then used to help evaluate decision quality and to develop new tools and questionnaires to evaluate patient satisfaction with their treatment decisions and outcomes.
What Have We Learned So Far
 Overall, Spine Center patients who viewed the Shared Decision Making programs before choosing a treatment reported high satisfaction with their preparation for decision making and high resolution of conflict about their decision.
Additionally, Spine Center patients who viewed the programs chose to have less invasive procedures than patients who did not participate in shared decision making.
Listen to the NPR report about the Dartmouth Hitchcock Spine Center - “For Back Pain, Few Easy Answers on Surgery”
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DHMC Comprehensive Breast Program
The Dartmouth Hitchcock Medical Center Comprehensive Breast Program
is a multi-disciplinary team effort that focuses on caring for the whole patient. Shared Decision-Making® programs about breast cancer surgery options, access to decision counseling, and screening for distress have eased the difficult process of making tough treatment choices for many patients.
The Comprehensive Breast Program (CBP) has found that it is feasible and beneficial to integrate decision support into routine care. Helping patients to clarify their preferences for competing treatments is an essential function of Shared Decision Making programs.
The Process:
 Before meeting with a surgeon, all patients at the CBP are scheduled for an intake appointment. Using a touchpad computer, patients complete a computerized, self-reported health history that includes an assessment of decisional conflict and treatment preference. After completing the survey, patients view the Shared Decision Making program: “Treatment Choices for Early Stage Breast Cancer”. A summary of the survey results is forwarded electronically to the surgeon, ensuring real-time clinical and decision process data for use during the consultation.
The Measurable Results:
Improved quality of patient/surgeon interaction
Increased satisfaction with the decision-making process
Reduced distress and decisional conflict
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Massachusetts General Hospital
The John D. Stoeckle Center for Primary Care Innovation is incorporating Shared Decision-Making® programs in an effort to improve patient involvement in decision making in primary care.
As an initiative in the primary care practices of Massachusetts General Hospital, eligible patients may receive one of 18 decision support programs through an “E-prescription” function that is integrated into the electronic medical record. Following discussion with the physician, this prescription triggers a number of actions including:
A one-page printed description of the program given to the patient by the physician,
An e-mail message to the distribution center with patient’s information, title and format of the program, and the prescribing provider’s name,
A prescription record logged into a database for research purposes.
The research underway at the John D. Stoeckle Center for Primary Care Innovation will:
Demonstrate the ability to introduce and disseminate decision support programs to patients within a pilot group of primary care physicians.
Identify and understand the barriers and problems faced by clinicians in making decision support programs an integrated part of the clinical practice of primary care.
Understand how the process of “e-prescribing” programs affects clinician workflow and time, e.g., overall office visit time, time spent with patient in the decision-making process.
Gain feedback from the patients about: their experiences, perceptions and satisfaction with receiving decision support programs; the effect the program has on their decision preference; what they think about the available options; and how they feel about making a decision.
This project will expand over time to include all MGH primary care physicians and offers great potential to increase the understanding of decision support in primary care.
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