Massachusetts General, one of the best-known hospitals in the country, is providing patients with a wide range of decision aids, including online resources, to help them learn about their treatment options and to better enable them to participate in making decisions about their care.
Both hard copies and digital tools are enabling patients to be better informed and to be more involved in decisions about their care, particularly for medical conditions for which there are multiple treatment options, helping them learn about both the benefits and risks of surgery.
The Shared Decision Making Program has taken the hospital on a 10-year journey from humble beginnings as a pilot in a single primary care practice to now encompass all of the hospital’s adult primary care practices, as well as specialty practices such as orthopedics, cardiology and obstetrics/gynecology.
“Over the past 10 years, we’ve been successful in getting shared decision-making integrated into routine care at Massachusetts General Hospital,” says Karen Sepucha, PhD, director of the MGH Health Decision Sciences Center and an assistant professor of medicine at Harvard Medical School. “A big part of what we’ve been doing over the past six years has been actually figuring out how to take all those research findings and put them into practice.”
Electronic health records are often a “trigger” for introducing the use of patient decision aids that include cancer screening, elective surgeries, depression, anxiety, and insomnia, Sepucha notes. During the first years of the program, physicians were responsible for placing orders for decision aids through the EHR system. However, decision aids have now been integrated into routine care, including automatic prompts to doctors.
“We’ve done some work with our [electronic] medical record to facilitate the ordering of patient decision aids generally and then specifically at key time points, such as referrals,” she adds.
Clinician training has been critical at the hospital for boosting physician as well as patient engagement. Between 2005 and 2015, more than 900 clinicians and other staff members have been trained in shared decision making; more than 28,000 orders for one of about 40 patient decision aids have been placed to support patient decisions.
The effort included training sessions for clinicians at the hospital’s 18 adult primary care practices. As a result of the training, the use of decision aids more than doubled; clinicians by the system reported just months later that the aids improved the quality of care and led to discussions with their patients at a more advanced level.
Partners HealthCare, the Boston-based nonprofit hospital and physician network that includes Massachusetts General Hospital, sees the value of the approach and plans to spread the program across the health system.
Sepucha and Leigh Simmons, MD, medical director of the MGH Health Decision Sciences Center, co-authored an article this month in Health Affairs detailing the hospital’s Shared Decision Making Program.
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