Shared Decision Making (SDM) Program Newsletter

Issue 27 | December, 2020

Shared Decision Making in Practice at MGB

Dear ,

Welcome to the Shared Decision Making (SDM) program newsletter. In this quarterly newsletter you will find: patient decision aid updates, project updates, and useful resources and links to support decision making in practice.

How to Design Your Own Patient Decision Aid!

Do you wish you had more tools to support decision making with your patients? Drs. Karen Sepucha and Leigh Simmons from the MGH Health Decision Sciences Center are leading a 3-part virtual workshop on Wednesday evenings, “How to Create a Decision Worksheet,” on December 9^th from 5pm- 6:30pm, January 20^th from 5pm-6:30pm, and February 24^th from 5pm-6:30pm.

The Decision Worksheet is a short, paper-based decision aid designed to support shared decision making in a clinical encounter. In previous workshops, participants have created decision worksheets for use in urogynecology, interventional radiology, and primary care. Session 1 will be focused on decision aid design and prototyping; Session 2 will be focused on individual feedback on participants’ draft decision aids, and Session 3 will be focused on implementation of the decision aid.

We welcome participation from physicians, residents, fellows, nurses, physician assistants, health educators, students, and others interested in shared decision making. If you are interested in participating, please RSVP to fmarques@partners.org.

*NEW* Decision Aids and Epic Tip Sheets for Ordering Decision Aids

There are now over 80 decision aid titles available in both English and Spanish to order for patients in Epic.

You can view the content from the following health conditions within Partners Handbook

Cardiology
Chronic Pain
Endocrinology
General health
Men's Health
Mental Health
Nephrology
Orthopedics: Joint & Spine
Pediatrics
Pulmonary
Women's Health

Use this Epic Tip Sheet to order a decision aid today!

Colorectal cancer screening during COVID-19

PCORI recently awarded Drs. Karen Sepucha & Leigh Simmons, the PRIMED Study investigators, a 1-year supplement to study the impact of a shared decision making intervention on patients' decisions about colon cancer screening.

The PRIMED-2 study is targeting patients aged 45-75 whose colonoscopy was cancelled, delayed or postponed due to COVID-19. This past summer, we surveyed MGH patients to assess their anxiety, COVID risk tolerance, cancer worry, willingness to screen, barriers to colonoscopy, and preference for alternative colon cancer screening options.

The quotes below illustrate the range of views that we heard from patients. We're working closely with the MGH GI Department to conduct a randomized controlled trial of a shared decision making intervention with these patients. Results should be ready in early 2021!

Consider alternate screening options:

“Still evaluating safety issues - My wife, who is an MD, wants me to postpone and go with stool-based test.”

“I didn’t know about the stool tests—that seems like an easier way to test right now.”

Delay screening:

“Can't get time off work! Do not want to be around hospital at this time.”

“I am at low risk and would rather wait another year. Relieved to not have to go in now.”

Resume screening with colonoscopy:

“I would very much like to have my colonoscopy scheduled since I usually have polyps removed + I had colon cancer. Although it has been 21 yrs, I still have a fear of recurring.”

"I have already had to delay my colonoscopy several times. I feel like delaying longer is putting me at greater risk.”

Informed Medical Decisions™ Program Update

The Informed Medical Decisions™ Program (IMDP) was established at Massachusetts General Hospital in April 2017 with generous funding from Healthwise. The IMDP continues the work of the Informed Medical Decisions Foundation, which was founded in 1989 with the mission to inform and amplify the patient's voice in health care decisions. The IMDP is housed within the Health Decision Sciences Center (HDSC) in the Division of General Internal Medicine and we work closely with the HDSC on many of our projects.

Here are a few highlights from our current projects!

Trust and Shared Decision Making

Our new 5-item measure of trust in the surgical decision-making process was just published in Annals of Surgery. We used the measure in a study that surveyed 700 patients across MGH and is exploring the impact of decision aids on building trust and reducing regret in patients undergoing elective orthopedic surgeries. We hypothesized that improving trust and decreasing regret should ultimately result in lower malpractice risk. We are currently analyzing the data and plan to publish the results soon. Funded by CRICO (Harvard’s medical liability carrier).

Defining Patient Preferences for a statin

We conducted a web-based study to describe the distribution of preferences for statin therapy across the spectrum of CVD risk. We surveyed 304 respondents aged 40-75 who had not taken a statin before. Based on their 10-year CVD risk, respondents were provided with an estimate of their absolute risk reduction and information about the risks of statins. Respondents then answered questions about their preference for a statin. We found:

· 45% of respondents reported they would definitely or probably take a statin

· As risk increased, the proportion who would take a statin increased

· A clear majority preference (>60%) for statins did not emerge until the 10-year risk was 20-50%

· For patients with a risk >10%, desire to take a stain decreased as respondents’ health literacy, subjective numeracy and knowledge scores increased.

With these findings as background, we submitted a grant to NIH/NHLBI to expand this work to clinical populations.

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