opportunity knocks - cffb.dk · opportunity knocks richard wexler, md [email protected] ....

Opportunity Knocks

Richard Wexler, MD

[email protected]

Opportunity realized

Lars Rasmussen Jens Rasmussen

Presentation outline

• Implementation framework for SDM programs

• Communications framework for SDM conversations

• Communication training and technology

SDM program plan elements

Patient-centered Communication training

SDM communication training

Patient decision aids

Leadership

Coordinating the effort

SDM conversation

Decision aids

Training

Implementation framework for SDM programs

Training Leadership

Training

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Engaging providers and staff in SDM

MOTIVATION = Importance + Confidence

Decision aid distribution timing

Before visit

During visit

After visit

Implement Deliberate & Decide

SDM conceptual framework*

Options

Risks & Benefits

Goals & Concerns

Invite

*Draws from Volk’s 21 SDM competency

themes1 & Makoul’s 9 essential elements2

Volk et.al. BMC Med Inf and Dec Mak 2014, 14:95 Makoul & Clayman, Patient Educ Couns 2006; 60:301-312


Silverman J., S.M. Kurtz and J. Draper(1998)

Invite

Options Risks and benefits Goals and concerns

Deliberate and decide Implement

We know what providers have difficulty with: • Understanding evidence and communicating risk • Determining patient role preference • “Eliciting patient preferences” • Listening

Inventory of SDM training programs1 shows:

• Great variance in design and content • Little evaluation activity • Effectiveness remains largely unknown

1Legare F, et al. Patient Educ Couns 2012; 88:159-169.

SDM Training Review

People learn new skills best when:

• They’re motivated

• Prior knowledge is acknowledged

• Prior misconceptions are corrected and known barriers are addressed

• They have lots of opportunities to practice

• They receive immediate feedback

• The content and experiences are relevant to their work or life

Adult Learning Theory Review

Training program design

• Scalable and flexible delivery—90 min, online

• Focuses on most challenging competencies

• Directly confronts barriers

• Emotionally and intellectually engaging

• Uses authentic scenarios

• Lots of opportunities for practice

SDM: What’s at Stake?


The Six Steps of Shared Decision Making


When Would You Use SDM?


What’s Stopping You? g You?


Listening for Patients’ Goals and Concerns


Practice the Conversation


Practice the Conversation

1

2

3

4

2

SDM With and Without Decision Aids


SDM Implementation: An Overview


Assessment of SDM Conversation Skills


Evaluation Group Health Cooperative

Seattle, Washington

USA

Provider SDM skills course

Follow-Up Assessment

Pre-Course Assessment

Post-Course Assessment

Skills Course

6 Weeks

• Orthopedic & Primary Care Providers given access to online course

• Successful completion yields $100 gift card + 1.5 hours of CME credit

• Course available for 6 weeks, providers may access at any time

• Assessments/Surveys at 3 time points:

23

also completed

the follow-up

assessment (47%)

28 completed

Pre- and Post-Course

assessments (57%)

39 completed

the course (80%)

Provider SDM skills course

49

Providers

invited to participate

Follow-Up Assessment

Pre-Course Assessment

Post-Course Assessment

Skills Course

6 Weeks

Provider attitudes: Did you notice reluctance in your patient subgroups to engage in SDM?

48%

42%

15% 15%

9%

45%

36%

3%

9%

3%

Before Training

After Training

Provider knowledge: Mean Percent Correctly Answered

61%

90%

74%

Providers: program evaluation

7%

39% 43%

11%

32

%

68

%

6 Weeks 4 Weeks

8 Weeks 8 Weeks

Patient Cohorts

Patient Surveys:

Baseline Skills Course

Available Patient Surveys:

Post-Implementation

• Patients who visited Primary Care and Orthopedic providers surveyed before the SDM Skills

Course was made available

• Patients who had visits with the providers after they completed the skills course were also

surveyed

• Questions about SDM interactions with providers if they discussed:

• Starting a new Rx medication • Having preventive screening for cancer • Whether or not to have surgery

• 58% ortho patients & 54% primary care patients discussed relevant topic

Patients: Interactions with Providers before & after training

79%

48%

78% 75%

49%

56%

75%

40%

70% 71%

51% 51%

Before Training

After Training

Limitations

• Sample size is small

• Some providers were previously trained in SDM skills

• No way of knowing how far along patients are in their decision-making journey

• Some patients may have been primed with DA’s

Conclusions • Half of patient visits included discussion of a topic appropriate for SDM

• Feasible for providers to participate in SDM Skills Course

• Most of those invited completed the course

• Most were interested in similar courses

• Most reported at least some information was new to them

• 65% maintained knowledge gain 4-6 weeks after completing the course

Opportunity realized

Thank you!

Tak!

opportunity knocks - cffb.dk · opportunity knocks richard wexler, md [email protected] ....

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