Evidence-Based
Shared Decision-Making in Adult Primary Care
| Developed by: |
David Price, MD, FAAFP
Director of Education,
Colorado Permanente Medical Group
Associate Professor Family Medicine and Psychiatry
University of Colorado Health Sciences Center |
| Format: |
Half-day session with didactic presentation
and small, problem-based learning groups (6-8 participants per group)
using case studies and role-playing. |
How Will Clinicians Benefit?
Clinicians will be able to discuss evidence-based recommendations and
apply shared decision-making (SDM) skills with patients and assure that
patient preferences are incorporated into diagnostic and treatment decisions.
Curriculum Description
This curriculum and toolkit help clinicians incorporate evidence-based
medicine (EBM) and SDM into their practices. Four topics commonly seen
in primary care practice are highlighted: mammography screening for
breast cancer m women between the ages of 40 - 49, prostate cancer screening
for men over age 50 using prostate specific antigen (PSA) testing, hormone
replacement therapy (HRT) for post-menopausal women, and antidepressant
or psychotherapy for treatment of mild to moderate depression.
Materials are designed for a half-day workshop that includes didactic
presentations (included on videotape) and experiential exercises to
introduce learners to concepts in EBM and effective communication skills.
In addition, documentation of SDM discussions in the medical record
is highlighted and "tip sheets" for useful phases to use in
patient encounters are developed.
Videotape of the didactic presentations and an explanation of how to
conduct the role-playing sessions are included in the curriculum materials.
Learning Objectives
At the conclusion of this half-day program participants will be able
to:
1. describe the evidence for mammography screening in women ages 40-49,
PSA testing in men over age 50, I-IRT for post-menopausal women and
antidepressants vs. psychotherapy for treatment of mild to moderate
depression;
2. demonstrate effective communication skills in discussing the efficacy
of these treatments with their patients;
3. elicit patient preferences in these areas;
4. document SDM of these topics in the medical record;
5. demonstrate high patient satisfaction with their involvement with
the treatment decisions.
Intended Audience
Clinicians in primary care or OB/GYN practice.
Pilot Testing
A total of 21 clinicians participated in the pilot testing. The program
was accredited for 4 hours of AMA category 1/ AAFP prescribed continuing
medical education credit.
The clinicians favorably evaluated the program. Two months after the
program, they completed a follow-up survey on what they had actually
implemented in practice. Ninety percent of the participants responded;
nearly all reported doing at least one thing differently in practice.
Responses fell into two main categories: 1) using evidence-based medicine
to discuss treatment options with patients, and 2) using featured communication
techniques, including some of the phases from the "tip sheet."
A pre- and post-workshop telephone survey is being conducted with patients
of clinicians in the pilot group. The survey will assess patients' satisfaction
with the information they received and their level of involvement in
treatment decisions. The results of this survey will be compared to
determine if the educational session improved patient satisfaction with
SDM.
Resources Needed to Use This Curriculum
- Facilitator: Faculty with a basic background in EBM
and skilled with facilitating interactive, problem-based learning
- Equipment: VCR and curricular materials
- Facilities conducive to viewing the videotapes, participating
in small group discussions as well as interactive sessions with large
group.
- Support staff: Assist with workshop logistics,
publicity, registration; duplicate workshop materials, evaluation
forms; summarize evaluations.
The
links below will take you to the Center for the Health Professions web site.
