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Options and Evidence: It's What Patients Want Washington, DC
Patients want more meaningful discussions with their care providers when making health care decisions, according to a new discussion paper released today by the Institute of Medicine. The survey found that 8 in 10 people want their health care provider to listen to them, but just 6 in 10 reported that it actually happens, and fewer than 4 in 10 say their provider clearly explains the latest medical evidence. Additionally, less than half of people surveyed reported that their provider asks about their goals and concerns for their health and health care.
"Simply stated, engaging patients in their own medical decisions leads to better health outcomes," concluded the authors, participants in the IOM's Evidence Communication Innovation Collaborative on behalf of its Roundtable on Value & Science-Driven Health Care. The paper is based on fresh qualitative and quantitative research, as well as an extensive review of relevant research on evidence- and medical-decision making, all commissioned by the collaborative.
Several authors discuss the research further in a just-released "Viewpoint" in the Journal of the American Medical Association, "Recognizing an Opinion: Findings from the IOM Evidence Communication Innovation Collaborative."
The authors say there are three essential elements to an informed decision based on shared decision-making. First, people must have timely access to the best available medical evidence. Second, providers must provide sound, unbiased counsel based on their clinical expertise. Third, patients' and families' goals and concerns must be actively elicited and fully honored.
"The gap between what people want and what they are getting leads to poor medical decision-making, but it also represents an opportunity to do better," said George Halvorson, chairman and chief executive officer of Kaiser Permanente and co-chair of the IOM collaborative. "We know how to get it right; with shared decision-making between patients and clinicians that produces informed decisions."
In the context of shared decision-making, the public does not view evidence as an indicator of cook-book medicine. Rather, a survey of 1,068 patients conducted by Consumer Reports National Research Center in the spring of 2012 for the IOM collaborative found that patients view evidence about what works for their condition as more important than either their provider's opinion or their personal goals and values.
"Doctors take note: People want and deserve meaningful engagement in conversations about their care, and they value it when rating their experience of care," said contributor John Santa, MD, director of the Consumer Reports Health Ratings Center. "They do not want their practitioner to make decisions for them or offer only some of the options."
The collaborative's goal is to accelerate the routine use of the best available evidence in medical decision-making. Bill Novelli, a professor in the McDonough School of Business at Georgetown University, former CEO of AARP and co-chair of the collaborative said the call to action is clear for the people who pay for care and provide care. "We need to make it easy to do the right thing by encouraging, empowering and motivating clinicians to facilitate informed medical decisions whenever and wherever they practice. Policy can foster this by changing the way we pay for care, by promoting high-quality tools to help clinicians inform patients, and by educating clinicians about best practices for communicating with patients."
The Evidence Communication Innovation Collaborative (ECIC) of the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care seeks to improve public understanding, appreciation, and evidence-based discussion of the nature and use of evidence to guide clinical choices. The collaborative includes communication experts, decision scientists, patient advocates, health system leaders and providers.
This research was led and conducted by MSL Washington, GYMR Public Relations, Lake Research and Consumer Reports National Research Center on behalf of the collaborative.
The report's authors are: Chuck Alston, MSL Washington; Lyn Paget, Informed Medical Decisions Foundation; George Halvorson, Kaiser Permanente; Bill Novelli, Georgetown University; Jim Guest, Consumers Union; Patrick McCabe, GYMR; Karen Hoffman, Consumer Reports National Research Center; Christopher Koepke, Centers for Medicare & Medicaid Services; Melissa Simon, Northwestern University; Sharyn Sutton, Social Enterprise Consultants; Sally Okun and Paul Wicks, PatientsLikeMe; Tresa Undem, Lake Research Partners; and Valerie Rohrbach and Isabelle Von Kohorn, Institute of Medicine.
The Communicating with Patients on Health Care Evidence discussion paper is part of a new category of IOM publications, "Perspectives" which offers personal observations and opinions of leading experts on developments in health and health care. Perspectives are aimed at informing the discussion on pressing issues before the nation. As personal views, they reflect the opinions of the authors, not the Institute of Medicine.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care, recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, their mission is to provide high-quality, affordable health care services and to improve the health of members and the communities served, currently serving more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.