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New Advances in Shared Decisionmaking Highlight June International Conference

Doctor talking with elderly patient

The 5th International Shared Decision Making Conference was held in Boston, Massachusetts, June 14-17, 2009. Specialists in the science of decisionmaking, policymakers, clinicians, and payers of health care from across the globe gathered to discuss the rapidly growing field of shared decisionmaking. Consistent with this year’s conference theme of “vision to reality,” considerable attention was given to the issue of implementation, with a focus on how to promote shared decisionmaking across clinical contexts.

Plenary sessions were conducted by leaders in the field. Glyn Elwyn from Cardiff University in Wales argued that shared decisionmaking and evidence-based medicine were one in the same. Jack Wennberg of Dartmouth College reviewed the history of research on practice variation, noting striking geographic differences in surgical rates and other preference-sensitive decisions. Gerd Gigerenzer from Max Planck Institute in Berlin argued that physicians can make good decisions using less information, and formal prognostic modeling may be no better than approaches using decision heuristics (or decisionmaking “short cuts”). This provocative area of research raises interesting questions for decision scientists, where it might be argued that decision heuristics can lead to “good” but perhaps not “informed” decisionmaking.

Susan Dentzer, Editor-in-Chief of Health Affairs, talked about the role of shared decisionmaking in U.S. health care reform. She noted the current backlash against comparative effectiveness research, some claiming it to be no more than a cost-saving or rationing approach, and wondered if shared decisionmaking efforts might meet similar challenges as health care reform moves ahead. Richard Thomson from the University of Newcastle raised the issue of shared decisionmaking interventions perhaps leading to poor outcomes for some patients. In the case of patients with atrial fibrillation, Thomson observed that some informed patients would decide against treatment with warfarin, increasing their risk for a subsequent stroke.

In the applied realm, the number of patient decision aids developed and formally evaluated over the past decade has increased tremendously. The Cochrane review of decisions aids for patients facing health treatment or screening decisions was recently updated and published in 2009. Fully 55 randomized controlled trials of patient decision aids have been conducted, and the updated review confirmed the 2003 review findings: decision aids improve care in terms of increased knowledge, decreased conflict about decisions, and greater preference for involvement in decisionmaking. The more recent evidence supports decision aids as enhancing the accuracy of risk perceptions among patients.

The International Patient Decision Aids Standards (IPDAS) Collaboration sponsored a workshop on its progress since the 2007 Freiberg meeting. In 2006 the IPDAS Collaboration published the results of an international online Delphi consensus process to identify quality criteria for developers and adopters of patient decision aids. The IPDAS Collaboration used the opportunity to announce plans to update the background documents that served as evidence summaries for drafting and voting on proposed decision aid quality criteria. The background documents are now over 4 years old and there has been a substantial increase in the number of patient decision aids developed, and the science of decisionmaking has advanced as well.

The conference also launched the second edition of Adrian Edwards’ and Glyn Elwyn’s edited volume Shared Decision-Making in Health Care: Achieving Evidence-Based Patient Choice. The book has grown to 56 chapters grouped within the broad areas of evidence-based patient choice, theory, conceptual developments, decisionmaking in practice, and future directions.

The International Shared Decision Making Conference was first held in Oxford, UK (2001), then in Swansea, UK (2003), Ottawa, Canada (2005), and Freiberg, Germany (2007). The event in 2009 was held for the first time in the United States.