Developing a Shared Decision Making Curriculum

1. Developing a Shared Decision Making Curriculum Angela Fagerlin, PhD

2. So Who Am I To Talk To You About Shared Decision Making Curriculum? • Co-Director of one shared decision making course at the Society of Medical Decision Making. • Will teach the SMDM course again this month as well as a 2nd course for researchers and clinicians at our Veterans Affairs hospitals/research centers. • I teach a 1week (40 hours) course on the development of decision aids.

3. Co-Director Mary Politi, PhD Assistant Professor Washington University St. Louis, Missouri

4. Instructors Dominick Frosch, PhD Karen Sepucha, PhD

5. Year 1: 4 Parts • Introduction / Overview of Shared Decision Making • Psychology of Medical Decision Making • Heuristics and Biases • Risk Communication • Decision Support Interventions • Development • Evaluation • Implementation • Measuring a Quality Decision

6. Introduction / Background Shared Decision Making Dominick Frosch, PhD

7. Introduction / Background • Define patient engagement • Relationship of SDM with evidence based medicine • Defining and relating equipoise to shared decision making

8. Introduction / Background • Steps in shared decision making • Identify situations in which SDM is critical • Acknowledge decision to patient • Describe options, including uncertainty • Elicit / construct preferences and values • Agree on a plan for the next steps • Benefits of shared decision making • Patients • Physicians

9. Psychology of Medical Decision Making Angela Fagerlin, PhD

10. Heuristics & Biases • Availability • Framing • Anchoring and adjustment • Default bias • Omission and action biases

11. Risk Communication • Numeracy • What it is, how bad it is, how crucial it is • Absolute vs. relative risk • Frequencies vs. percentages • Graph communication • Baseline vs. incremental risk • Less is more • The importance of labels

12. Decision Support Interventions Development and Evaluation Mary Politi, PhD

13. Decision Support Interventions Development and Evaluation • What are decision support interventions (DESIs)? • What have they been proven to do? • Where is more research needed? • How are DESIs developed? • How are DESIs evaluated? • How are DESIs implemented?

14. Decision Support Interventions Development and Evaluation • Resources • Development: http://decisionaid.ohri.ca/ • http://ipdas.ohri.ca/ • Evaluation • http://ipdas.ohri.ca/ • IPDASi: http://www.ipdasi.org/IPDASi%20Information.pdf

15. Decision Quality Karen Sepucha, PhD

16. Model of medical care • Inputs / Process / Outputs • Research continuum: Patient decision aids • Development  Evaluation  Implementation • Criteria for appraising survey instruments • Validity and reliability

17. Resources • OHRI common decision aid measures: https://decisionaid.ohri.ca/eval.html • • NCI-GEM SDM measures and reviews: www.gem- beta.org • • MGH decision quality instruments: http://www.massgeneral.org/decisionsciences/ • • IPDAS chapter on evaluation (BMC) • • CAHPS group (SDM requirement for PCMH and ACOs): http://cahps.ahrq.gov/clinician_group/

18. Interactive Activities

19. 2 Exercises • Evaluation of decision • 3 groups—each received a different decision aid • Used IPDAS (checklist) criteria to evaluate the quality of the tool • Evaluation of traditional research project vs. an implementation project in routine care. • Provided handouts that describe one of the two research projects described above. • Asked participants to reflect on • What is the goal of the project • What are the most important outcomes/data to collect • What are approaches/surveys that could assess outcomes • Strengths and weaknesses of different approaches

20. How Did Learners Like Us?

21. Our Evaluations • Pretty Well… • Among the best courses I have ever taken: N = 1 • A very good course w/ minor weaknesses: N = 8 • A good course but significant room for improvement: N = 1 • A very weak course: N = 1 • 10 out of 11 would recommend this course to colleagues • Interactive involvement • Too little: N = 1 • Just the right amount: N = 8 • Too much: N = 2

22. Comments from Evaluations • Too many speakers • Introduction too long • Not enough on heuristics and biases • Didn’t provide handouts • Disagreement on the value of the interactive exercises

23. Conclusions From Our First Attempt • Our initial attempt was too ambitious • Tried to cover too much in too little time • Needed to make sure people kept to the time limit and that we were more thoughtful about how to focus/split up the content. • It might not be feasible to teach a truly comprehensive SDM curriculum in a short course setting. • Too many subtopics, so little time.

24. Round 2: Upcoming Course • Will decrease: • Number of speakers from 4 to 3 (but due to maternity leave, only 2 will be there). • Introduction • Decision Quality • Increase • Discussion of heuristics and biases that affect medical decision making • Discussion of how to decrease these biases • Change interactive exercises

25. Development of Decision Aids Course taught at New York University (2011 Currently)

26. Process • Lecture & lab in the morning • Lecture & lab in the afternoon • Sharing of decision aid development challenges • Day 1 • Background on models of patient-physician decision making. • What are decision aids? What they have been proven to do, not do? • Day 2 • Literacy • Numeracy / Risk communication

27. Day 3 • Preference elicitation • Tailoring • Day 4 • Web-based Decision Aids • Implementation • Day 5 • Survey design and evaluation • Presentation of decision aids

28. One Last Resource Slide • Mary Politi teaches a course of shared decision making and shared this link to her course and syllabus: • http://www.mphs.wustl.edu/Courses/MPHS%20Elective#M19-560http://www.mphs.wustl.edu/Courses/MPHS%20Elective#M19-560 • Paul Han (Risk Communication Module, designed for medical students) • Han et al., Development and evaluation of a risk communication curriculum. Patient Education and Counseling, 2014.

29. You Can’t Ask Me Questions (NOW) • But you can ask me later (or now, by email) fagerlin@med.umich.edu @angiefagerlin www.cbssm.med.umich.edu