A professor of mine once announced that some of the lowest vaccination rates were for children whose parents are busy executives in New York City. These families had good insurance and great access to care, but the parents had no time to take their kids to the doctor. An emerging tool called patient decision aids will not vaccinate your children, but might save time and determine whether a visit with the doctor is in order. Questionnaires found online or connected to provider websites or electronic patient portals can offer guidance, for example, about whether someone should be evaluated by a doctor for depression or influenza.
The tools also enhance patient involvement with health care providers in medical decision-making. Studies have found improved outcomes when patients are more involved when making decisions about treatment and well-being. The evidence shows that shared decision-making enhances patient-provider collaboration in health care.
Whether in pamphlet, video or online form, the tools are designed to help patients understand options for screening and treatments.
Communicating about your decisions with your provider is critical. As a recent editorial noted in the highly respected journal Medical Decision Making, there are several benefits from having "a shared perspective" with your health care provider. These include increased likelihood of "satisfaction with the physician and with the clinical encounter, and trust in and endorsement of the physician’s recommendations." While the evidence on some outcomes such as consultation time remains inconclusive, it appears that the overall benefits of these aids warrant their continued use and further development.
Many aids are available free online at decisionaid.ohri.ca. This link will take you to a library of online questionnaires for conditions that range from acne and sleep disorders to cancer and diabetes. The aids are rated on quality by the International Patient Decision Aids (IPDAS) Collaboration, so be sure to check their score if you use them.
Locally, University of Hawaii professor Dana Alden is working with a team of medical and social science researchers to find ways to improve patient decision aid effectiveness for patients with diverse ethnic backgrounds in Hawaii. His team is developing and testing culturally sensitive decision aids designed to enable participation in their health care planning and decision making to the level desired by the patient.
In some cases, patients may review the decision aid at home before their appointment. In other cases they may review the decision aid in clinic or with their provider. Regardless, this work offers an exciting prospect of increasing patient participation in decision making that affects their future.
In addition to research, an important component of Alden’s project is a conference on patient-provider decision-making that will bring leading experts in the field to Honolulu to share the latest thinking on shared decision-making and decision aid technology. The conference is planned for March.
The research is still out on actual cost-savings derived from implementing the aids. However, given that patients are generally more satisfied with decisions they make when using them in conjunction with their provider, this is likely to result in less unnecessary testing and treatment, and fewer lawsuits. In addition, as the aids can do a lot of "option educating" and "value checking," they should improve consultation time-efficiency, leading again to savings.
From the standpoint of the individual with a busy work schedule, such tools can help determine whether it really is time to see your provider and, once there, to ensure that time is well spent.
In any case, take time to vaccinate the kids.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
