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March 1, 2017

Getting patients involved in their care is hard. These 3 strategies can help.

Daily Briefing

    More providers are taking steps to get patients more involved in their own care, which research shows can improve patient engagement and outcomes, Laura Landro reports for the Wall Street Journal.

    In the traditional doctor-patient relationship, patients generally "let the doctors decide," Landro writes. But that is changing as the health care system evolves and encourages patients to manage chronic conditions proactively and make informed decisions about treatment decisions.

    But for many patients, taking these steps can be difficult. "Some are overwhelmed by the choices they have to make about their care," Landro explains, while "many doctors are reluctant to change old ways of working."

    Fortunately, providers are learning what strategies work to increase patient engagement and untie the "doctor-knows-best knot," Landro writes.

    Benefits of shared decision-making

    Angie Fagerlin, chair of the department of population health sciences at the University of Utah and president of the Society for Medical Decision Making, said many health conditions don't have "a clear best [treatment] option." Finding the right answer can take a doctor and patient working together. "Shared decision-making allows patients to engage in a deliberative, communicative process with their clinicians, and be active participants in their care," Fagerlin explained.

    "Studies do show that [shared decision-making] leads to better outcomes, fewer invasive procedures, and lower costs," Landro writes. And patients who engage in health care decisions with their doctor "are less likely to regret the choices they make and more likely to stick to the treatment regimens they select." However, there is little research about how shared decision-making affects long-term health.

    For instance, a 2013 study in Health Affairs found that patients who received guidance from health coaches to become more involved in their care had 12.5 percent fewer hospital admissions and elective surgeries and 5.3 percent lower medical costs. In some cases, doctors can benefit too, such as through CMS programs that incent them to engage in shared decision-making.

    Landro highlights three key strategies that researchers have identified as particularly helpful in engaging patients in their care:

    1. Decision-making aids

    One key patient engagement tool is decision-making aids, Landro writes. She explains that the materials, "once limited to print pamphlets and brochures, now include interactive programs and videos that patients can view online." According to Landro, the aids can walk patients through benefits and harms of a given procedure.

    A 2014 study in Cochrane Review found that decision-making aids increase patient engagement in their treatment and help them feel more informed. The study also "concluded that the aids reduce the number of people choosing elective surgery and have no apparent adverse effects on health outcomes or satisfaction," Landro writes.

    From 2005 to 2015, Massachusetts General Hospital launched a major program to expand the use of decision-making aids by training more than 900 clinicians and other staff in their use. A 2016 study in Health Affairs found the program more than doubled the use of decision-making aids, and physicians said the aids changed their discussions with patients and improved the quality of patient care.

    2. Communicating with patients

    Providers also are working to improve how they present complex medical information to patients, Landro writes.

    For instance, Brian J. Zikmund-Fisher, an associate professor at the University of Michigan School of Public Health, and colleagues built a web application that enables providers to create easy-to-understand graphics that use icons to convey risk information. "Their research has found that presenting information about test results and treatment options in such formats can help patients understand the incremental benefits of risk-reducing treatments and the risk of developing side effects from medications," Landro writes.

    Shared decision making: Sometimes, the doctor knows best

    But patients also can be overwhelmed by too much information, Landro writes. For instance, in another study, Zikmund-Fisher found that breast cancer patients who were given information about treatment decisions in smaller chunks had better comprehension of risk information than patients who evaluated all of their options at once.

    3. Patient access to EHRs

    Another approach to increasing patient involvement in decision-making is to give patients access to part or all of their electronic health record (EHR), Landro writes. Some providers are even letting patients view the notes doctors write about them with a technology called OpenNotes developed at Beth Israel Deaconess Medical Center. "The VA and 50 health systems in 35 states now share notes with about 12 million patients online," Landro writes.

    That type of transparency may make some doctors nervous. But OpenNotes co-founder Tom Delbanco, a primary-care physician at Beth Israel and professor at Harvard Medical School, said doctors are warming up to the idea as research shows "that access helps patients understand the importance of playing an active role in their own care."

    For instance, a 2010 trial of the software found about 66 percent of patients who read doctors notes about themselves felt more in control of their care, felt better prepared for office visits, and had an improved understanding of their health. In 2015, a Geisinger Health System study found the software also helped boost medication compliance.

    Some providers worry that patients will not be able to understand doctors' notes, Landro writes. To that end, the American Journal of Medicine last year released guidelines for doctors related to sharing notes with patients that suggested avoiding jargon and abbreviations to avoid confusion (Landro, Wall Street Journal, 2/26).

    Help patients take an active role in their care

    Even the best care won't result in strong outcomes unless patients are ready and willing to follow care recommendations, make necessary lifestyle changes, and play an active role in managing their own care.

    That's why it's crucial that frontline clinicians have the skills to tap into patients' motivation to change. Our toolkit gives managers the resources they need to help clinicians do just that.


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