Empowering Consumers Through
Information Therapy
What is the evidence?
Dawn Stacey PhD
Assistant Professor, University of Ottawa, Ottawa
Associate Scientist, Ottawa Hospital Research Institute
dstacey@uottawa.ca;
Key Messages
- Patient decision aids:
- Consistently improve knowledge and prepare patients for
discussing decisions
- Reduce elective surgery by 24% (prostate, spine, uterus)
– Involved patients have better outcomes
– Implementation requires
• Training for patients/professionals
• Integration in routine care
Stacey 2010
Outline
• What is a patient decision aid?
• Do patient decision aids work?
• How do we get them used?
Stacey 2010
Patient Decision Aids
adjuncts to counseling
Inform:
• facts
• probabilities
Clarify values
• experience
• ask
Support
• guide
• summary worksheets
Stacey 2010
International Patient Decision Aid Standards
(IPDAS) Collaboration
Home
What are
Patient Decision
Aids?
Who’s Involved?
Contact Us
Elwyn et al.,
(2006) in BMJ
333(7565):417
Ewyn et al.
(2009) in PLoS
ONE, 4(3), 1-9
Objective: Establish internationally approved
criteria to determine the quality of patient decision
aids. These criteria are helpful to individuals and
organizations that use and/or develop patient
decision aids:
– Patients
– Practitioners
>100 participants
– Developers
from 14 countries
– Researchers
– Policy makers or payers
To learn more, visit: www.ohri.ca/decisionaid
Stacey 2010
Summary Report for Surgeons
Stacey 2010
Stacey, D. et al. BMJ 2008;0:bmj.39520.701748.94v2-bmj.39520.701748.94
Compared to standard care,
patient decision aids …
15%  knowledge scores
70%  accurate risk
perception
50%  undecided
40%  passive in decision
making
~ Decisions
-24% surgery; -20% PSA;
-29% HRT
no effect on other decisions
 No/minimal effect on anxiety,
satisfaction, health outcomes
? Costs, communication,
adherence, degree of detail
required
O’Connor et al., Cochrane Library, 2009
Stacey 2010
Decision Aids reduce rates of
discretionary surgery by 24%
0%
25%
50%
75%
CA-Prostatectomy
CAOrchiectomy*
back surgery
mastectomy
RR=0.76 (0.6, 0.9)
mastectomy*
.
hysterectomy
hysterectomy*
bphprostatectomy
Standard Care
D-Aid
bphprostatectomy
coronary bypass*
coronary bypass
Stacey 2010
(O’Connor, Bennett, Stacey et al., Cochrane Library, 2009)
Decision aids are not enough: change in
decisional needs of women considering breast ca surgery (n=125)
Uninformed
Unclear
Values
Unsupported
Stacey 2010
(Collins ED et al. 2009 in J Clinical Oncology)
Uncertain
Total DCS
Coaching may $0
be needed
$500
$1,000
(hysterectomy)
Standard care,
$2,751
Decision Aid
Alone, $2,026
(Kennedy et al. JAMA 2002;
288: 2701-2708)
Stacey 2010
Decision Aid
PLUS Coaching,
$1,566
$1,500
$2,000
$2,500
25 Reviews:
22 Reviews:
Health Literacy
Interventions
Clinical Decision
Making
Interventions
0
5
10
15
20 0
5
10
15
67 Reviews:
Self Care &
Chronic Disease
Self Management
interventions
20
0
20
40
60
Knowledge
Positive
Mixed
No Effect
Experience
UseHealthService
Behaviour and
Health Status
Stacey 2010
Patients involved in decision making
• Improve
– quality of life
– sense of control over illness
– symptom relief
• Decrease
– fatigue
– depression
– illness concerns
However, most patients would prefer more active
involvement
Stacey 2010
(Kiesler & Auerbach 2006, Pt Ed Counsel, 61:319-341)
To improve adoption of shared
decision making by healthcare
professionals…
Need to use multiple interventions (4/5 trials):
• Educational materials (e.g. patient decision aids, coaching protocols)
• Training for health professionals
• Audit and feedback
• More research needed on costs and necessary resources
F Légaré, S Ratté, D Stacey, J Kryworuchko, K Gravel, ID Graham,
S Turcotte, PO D’Amours, January 2010 preliminary results
GOOGLE: ‘decision aid’
Stacey 2010
Stacey 2010
Stacey 2010
Key Messages
- Patient decision aids:
- Consistently improve knowledge and prepare patients for
discussing decisions
- Reduce elective surgery by 24% (prostate, spine, uterus)
– Involved patients have better outcomes
– Implementation requires
• Training for patients/professionals
• Integration in routine care
Stacey 2010
Stacey 2010
www.ohri.ca/decisionaid
Empowering Consumers Through
Information Therapy
What is the evidence?
Dawn Stacey PhD
Assistant Professor, University of Ottawa, Ottawa
Associate Scientist, Ottawa Hospital Research
Institute
dstacey@uottawa.ca;