Presentation Abstract

Title: Integrating Shared Decision-Making Tools Into Heath Care Delivery Systems

Shared decision making can be described as an approach where physicians and patients make decisions together, using the best available evidence about the likely benefits and harms of each option, and where patients are supported to arrive at informed preferences. Excellent interpersonal communication forms the foundation of this approach, and the delivery of accessible high-quality information can facilitate the process, especially if attention is paid to balance, and effective risk presentation. Well-designed tools that provide decision support to patients and clinicians can help facilitate shared decision making and likely reduce health inequities. There is, however, very little evidence that a process of shared decision making, either with or without the support of patient-facing information tools, has become integrated into healthcare delivery systems. A recent narrative review was not able to find many examples of electronic health record systems that explicitly supported shared decisions making in practical ways. The increasing emphasis on preventative care is an opportunity to stimulate shared decision making. When offering effective screening or risk reduction strategies, there are opportunities to identify individuals prior to clinical visits in order to promote the use of information tools that may catalyze shared decision making. Nevertheless, few delivery systems have invested in well-organized registers of people who are eligible for preventative care interventions, and there is no evidence that healthcare systems have adopted patient-facing information tools to promote uptake on the basis of informed choice.

About Dr. Elwyn

Glyn Elwyn’s training as a primary care clinician led to a research career focused on shared decision making, risk communication, the design and evaluation of patient decision support interventions, and their integration into practice. He is a Professor of The Dartmouth Institute for Health Policy & Clinical Practice, and of Community and Family Medicine, Geisel School of Medicine at Dartmouth. He is an Honorary Distinguished Research Professor at Cardiff University where he was Director of Research at the School of Medicine (2008–2011). In addition, he is a Permanent Visiting Professor at the Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands, and at the Research Department of Clinical, Educational & Health Psychology, University College London, United Kingdom.

Glyn Elwyn developed the International Family Practice Maturity Matrix, a measure of organizational development in primary care. He co-chaired the International Patient Decision Aids Standards Collaboration from 2004 to 2017, producing a checklist and a validated measure. In 2013, he received a lifetime achievement award at the 7th International Shared Decision Making Conference, Lima, Peru. He has published 385 peer-reviewed articles and authored/co-authored four books. He was lead editor of Shared Decision Making in Healthcare: Achieving Evidence-based Patient Choice, 3rd ed. Dr. Elwyn developed the Observer OPTION instrument, a widely-used observer-based measure of shared decision making, and collaboRATE, a patient-reported measure of shared decision making. He founded the International Option Grid™ patient decision aid collaborative, tools that are now licensed to, and produced by, EBSCO Health. Dr. Elwyn’s career has been focused on health service research, focusing on implementation science, across a range of conditions, using a range of quantitative and qualitative methods.

Dr. Elwyn disclosed the following conflicts of interest. He has publishing royalties from Oxford University Press; consults for the Washington State Health Department and other companies focused on shared decision making; and has copyrights to measures focused on shared decision making (non-financial).