Decision-making: supporting patients through their healthcare journey Maggie McDow, Director of Quality, Clinical Governance, and Chief Nursing Officer, Bupa UK 28 February 2014

2 Our purpose

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Bupa in the UK: Our focus is your health 4 17,000 patients supported with out-of-hospital care 32,000 people work for Bupa in the UK Our Home Healthcare business provides out-of- hospital healthcare to more than 17,000 patients. 3.5 million claims for treatment every year. 17,900 residents in over 300 care homes 32,000 people work for Bupa in the UK 2.7m customers in UK

Nursing at Bupa Our focus is on the health and wellbeing of our 2.7 million customers in the UK. 5 Acute nursing Health information and advice Specialist dementia care Community nursing Home medication delivery Health coaching Occupational health Enablement care Specialist nursing Parenteral nutrition

How we strive to consistently deliver the very best care 6 High quality care Delivering care that is right for each individual Ensuring the care our customers receive meets professional standards Providing care according to established clinical pathways Measuring and reviewing outcome data High quality service Acting as an effective steward of patients time and resources Demonstrating professionalism Ensuring informed financial consent Asking customers for their feedback to support continuing improvement

Shared decision-making: at the heart of Bupas 2020 vision 7 I trust Bupa to be there for me Bupa is committed to tackling rising healthcare cost while ensuring better outcomes

Our global commitment to shared decision-making 8 Sanitas Responde: 35 nurses offer a telephone service in prevention, chronic disease management and other areas such as smoke cessation, stress or depression Bupa Health Dialog HQ in Boston: DECISION Dialog® program - built on the principle that empowered consumers can take charge of their healthcare decisions Bupa Health Dialog Australia: In Australia, Bupa Health Dialog touched the lives of more than 51,000 people in 2012 Bupa Global Second medical opinion (Advanced medical): Access to a second opinion from leading experts in the relevant field, who review diagnosis & treatment plan & recommend any change

Health coaching in practice: Exploring patient needs for decision- making and providing support Karen Abinett, Health Coach, Bupa

Facilitate appropriate use of healthcare Empower individuals with information, skills, confidence, and motivation Health coaching mission Improve health and quality of care

Health coaching Meet individuals where they are Engage individuals Identify opportunities Guide individuals where they need to be Develop a plan Goals Tools Approved Web sites There is more than one way to achieve goals. Communication skills Decision aids Client resources Shared Decision-Making Framework Long term Condition Framework Community resources Health coaching model Motivational Interviewing Decision – making journey Building & maintaining the alliance

What is shared decision-making? A healthcare professional communicates information about the options, outcomes, probabilities, and scientific uncertainties of treatment options A patient communicates his or her values and the relative importance he or she places on benefits and harms Patient Experts MDT Health CoachPhysician

One way (usually) Provider to patient Clinical Minimum legally required Provider and colleagues Provider One way (primarily) Provider to patient Clinical All relevant for decision- making Patient (& others) Patient Two way Provider and patient Relevant for patient needs in context of the situation Provider and patient (potentially others) Provider and patient Clinical and personal Models of decision-making PaternalisticSharedInformed

The purpose of shared decision-making is to: Improve the quality of health decision-making and healthcare by helping individuals and their doctors communicate about the personal side of illness prevention and treatment. Provide evidence-based, unbiased medical information to a person who is facing a healthcare decision while also taking into consideration that individuals values, beliefs, and preferences. Improve the quality of health decision-making and healthcare by helping individuals and their doctors communicate about the personal side of illness prevention and treatment. Provide evidence-based, unbiased medical information to a person who is facing a healthcare decision while also taking into consideration that individuals values, beliefs, and preferences.

Bupas approach to shared decision making 15 - Patients and clinicians work together throughout - The patient has a clear view of all options - Decisions based on evidence and patient preference - Decisions made jointly by patients and clinicians Working together - Goes further than traditional informed consent - Identifies an individual's values and preferences for risk and benefits, and the probabilities of possible outcomes More than informed consent -Decision aids providing access to reliable, evidence based information -Counselling from a health coach -A system to support the delivery of a patients preferences Support tools

Health coaching in practice at Bupa 16 No decision about me without me Risk stratification to identify customer needs Improved outcomes Decision aids Supporting customers since early 2008 Treatment Options Service created in 2011, coaching to over 12,000 customers to date Team of eight nurses Using intelligent analytics to ensure targeted coaching for customers with most need for treatment decisions and chronic condition support Support from booklets and DVDs to allow patients to take information about their condition and treatment decisions away to digest at their own pace. SDM and Whole Person Health Coaching help people make informed decisions about their health, leading to better outcomes and patient experience

Preference-sensitive care conditions (PSC) Herniated Disc Herniated Disc Hip & Knee arthritis Early stage breast cancer Prostate cancer Prostate cancer Coronary artery disease Benign uterine conditions

Decision-support framework Health Dialogue 2010® 18 Exploring decisional needs Identifying and providing decision support Evaluating the quality of decisions

Individuals experience of Shared Decision Making 19 SDM – treatment for early stage prostate cancer SDM – treatment for herniated disc SDM – Health Coaching telephone call

Are decision aids alone sufficient? Control group Information only (video & booklet) Information and nurse-led interview just before specialist visit CASE STUDY Aim: Evaluate effect of decision aids with and without interviews. 894 women in UK with uncomplicated menorrhagia were randomly allocated to one of three study arms: CASE STUDY Aim: Evaluate effect of decision aids with and without interviews. 894 women in UK with uncomplicated menorrhagia were randomly allocated to one of three study arms:

Empowering patients to make quality medical decisions Interview and info group women were significantly less likely to have hysterectomy. Interview and info group had lower medical costs compared to control and info-only groups. There were no differences in health outcomes (SF-36).

Summary Provide evidenced-based, unbiased information Clarify personal beliefs, values, and preferences Enhance provider/patient communication Provide Clarify Enhance

Assessing the impact of shared decision-making 23 Customers more informed = often less invasive treatments 89% of customers are extremely or very satisfied with the service Offering support to people with chronic conditions has allowed them to manage their conditions better Conservative treatment choices have led to a reduction of 300+ surgeries Claims savings of 10% across engaged customers, generating 14% claims savings

Our future vision for shared decision making within Bupa 24 Deliver helpful and effective online decision aids to support SDM Customers with preference sensitive conditions will have the option of Health Coaching and/or the use of decision aids All Bupa recognised clinicians, therapists and other healthcare professionals to understand our approach to SDM Share and learn from best practice on SDM within both the private and public sectors Continue to develop and expand our health coaching team

For more information on Bupa visit or speak to us on Stand 4.