DEVELOPING A SHARED DECISION MAKING CURRICULUM Angela Fagerlin, PhD

So Who Am I To Talk To You About Shared Decision Making Curriculum?  Co-Director of one shared decision making course at the Society of Medical Decision Making.  Will teach the SMDM course again this month as well as a 2 nd course for researchers and clinicians at our Veterans Affairs hospitals/research centers.  I teach a 1week (40 hours) course on the development of decision aids.

Co-Director Mary Politi, PhD Assistant Professor Washington University St. Louis, Missouri

Instructors Dominick Frosch, PhDKaren Sepucha, PhD

Year 1: 4 Parts  Introduction / Overview of Shared Decision Making  Psychology of Medical Decision Making  Heuristics and Biases  Risk Communication  Decision Support Interventions  Development  Evaluation  Implementation  Measuring a Quality Decision

Dominick Frosch, PhD Introduction / Background Shared Decision Making

Introduction / Background  Define patient engagement  Relationship of SDM with evidence based medicine  Defining and relating equipoise to shared decision making

Introduction / Background  Steps in shared decision making  Identify situations in which SDM is critical  Acknowledge decision to patient  Describe options, including uncertainty  Elicit / construct preferences and values  Agree on a plan for the next steps  Benefits of shared decision making  Patients  Physicians

Angela Fagerlin, PhD Psychology of Medical Decision Making

Heuristics & Biases  Availability  Framing  Anchoring and adjustment  Default bias  Omission and action biases

Risk Communication  Numeracy  What it is, how bad it is, how crucial it is  Absolute vs. relative risk  Frequencies vs. percentages  Graph communication  Baseline vs. incremental risk  Less is more  The importance of labels

Mary Politi, PhD Decision Support Interventions Development and Evaluation

 What are decision support interventions (DESIs)?  What have they been proven to do?  Where is more research needed?  How are DESIs developed?  How are DESIs evaluated?  How are DESIs implemented?

Decision Support Interventions Development and Evaluation  Resources  Development:   Evaluation   IPDASi:

Karen Sepucha, PhD Decision Quality

 Model of medical care  Inputs / Process / Outputs  Research continuum: Patient decision aids  Development  Evaluation  Implementation  Criteria for appraising survey instruments  Validity and reliability

Resources  OHRI common decision aid measures:  NCI-GEM SDM measures and reviews: beta.org  MGH decision quality instruments:  IPDAS chapter on evaluation (BMC)  CAHPS group (SDM requirement for PCMH and ACOs):

Interactive Activities

2 Exercises  Evaluation of decision  3 groups—each received a different decision aid  Used IPDAS (checklist) criteria to evaluate the quality of the tool  Evaluation of traditional research project vs. an implementation project in routine care.  Provided handouts that describe one of the two research projects described above.  Asked participants to reflect on What is the goal of the project What are the most important outcomes/data to collect What are approaches/surveys that could assess outcomes Strengths and weaknesses of different approaches

How Did Learners Like Us?

Our Evaluations  Pretty Well…  Among the best courses I have ever taken: N = 1  A very good course w/ minor weaknesses: N = 8  A good course but significant room for improvement: N = 1  A very weak course: N = 1  10 out of 11 would recommend this course to colleagues  Interactive involvement  Too little: N = 1  Just the right amount: N = 8  Too much: N = 2

Comments from Evaluations  Too many speakers  Introduction too long  Not enough on heuristics and biases  Didn’t provide handouts  Disagreement on the value of the interactive exercises

Conclusions From Our First Attempt  Our initial attempt was too ambitious  Tried to cover too much in too little time  Needed to make sure people kept to the time limit and that we were more thoughtful about how to focus/split up the content.  It might not be feasible to teach a truly comprehensive SDM curriculum in a short course setting.  Too many subtopics, so little time.

Round 2: Upcoming Course  Will decrease:  Number of speakers from 4 to 3 (but due to maternity leave, only 2 will be there).  Introduction  Decision Quality  Increase  Discussion of heuristics and biases that affect medical decision making  Discussion of how to decrease these biases  Change interactive exercises

Course taught at New York University (2011  Currently) Development of Decision Aids

 Process  Lecture & lab in the morning  Lecture & lab in the afternoon  Sharing of decision aid development challenges  Day 1  Background on models of patient-physician decision making.  What are decision aids? What they have been proven to do, not do?  Day 2  Literacy  Numeracy / Risk communication

 Day 3  Preference elicitation  Tailoring  Day 4  Web-based Decision Aids  Implementation  Day 5  Survey design and evaluation  Presentation of decision aids

One Last Resource Slide  Mary Politi teaches a course of shared decision making and shared this link to her course and syllabus:  #M http:// tive#M #M http:// tive#M  Paul Han (Risk Communication Module, designed for medical students)  Han et al., Development and evaluation of a risk communication curriculum. Patient Education and Counseling, 2014.

You Can’t Ask Me Questions (NOW)  But you can ask me later (or now, by