Sunday, May 24, 2015

Decision aids in serious illness: dissemination strategy, anyone?

An example decision aid in serious illness: Prepare,

by: Alex Smith, @AlexSmithMD

I was fortunate to be part of a really nice systematic review of decision aids for patients with serious illness by Adrian Austin (senior author Laura Hanson).  This manuscript was published online ahead of print in JAMA: Internal Medicine last week.

For this study, Austin reviewed nearly 10,000 titles to identify 38 rigorous studies that meet inclusion criteria.  Seventeen were randomized controlled trials.

I'm not going to summarize the article here - suffice it to say there are a number of very promising decision aids to help people with serious illness.  The article is self explanatory, and I highly recommend that people at a minimum look at the tables to see if there are decision aids you might like to incorporate into your practice. Note, you have to be a JAMA: Internal Medicine subscriber to read the article.

I'd like to pose a question, raised in part by James Tulsky in his terrific accompanying editorial.  James says:
Hospitals and health care systems must make the commitment to introduce such tools at the point of care to ensure that patients facing decisions have the resources they need when they need them. Most of the tools reviewed by Austin et al are free and could be disseminated relatively inexpensively.
Emailing with Laura Hanson and Rebecca Sudore after the paper was accepted, we were at a loss as to what the next steps should be for dissemination.  In many ways, we are at a similar point to where we were after conducting a systematic review of prognostic indices for older adults.  We decided (spurred by Lindsey Yourman) to put the prognostic indices in our review online - voila!  ePrognosis.

But these decision aid tools differ from prognostic indices in important respects. Several include booklets.  While many are free, others are proprietary videos that must be purchased.  A few do not appear to be publicly available at all.  These are not as amenable to a website compendium or toolkit, like ePrognosis.

The problem is that busy clinicians will not use these tools unless they are easily available.   Putting them in one place, or linking them somehow, makes a tremendous amount of sense.

So my question for you - does anyone have a dissemination strategy for decision aids in serious illness?


Kquotes Com said...

very nice blog post.

Joshua Uy said...

Here are some random thoughts
Direct to consumer advertising w/access to an online warehouse (like
Make it a mandatory reporting requirement like BB for CHF or asa for MI, and then report it
Give people $ off their copays if they use one
Give docs extra money if they use one (i.e. give it it's own CPT code like vaccine administration but decision aid administration) or penalizing it's use
Make it a requirement for specific procedures like a palliative consult before LVAD's.