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The Ottawa Hospital: Supporting patients in making decisions about their care

by admin admin | Aug 18, 2010

Key Messages

Patient decision aids help patients learn more about their condition and their treatment options and help them decide what is important in choosing treatment options.

Patient decision aids have the same benefits as one-on-one education – but at much less cost, freeing up resources for other needs.

Patient decision aids don’t make appointments longer; they permit health professionals to spend less time educating and more time helping patients make the choices that are best for them.

"Everyone knows" are just two words at the beginning of a sentence, but they carry a world of meaning.

Take patient decision aids – educational tools that provide patients with information on a particular health topic. "Everyone knows" that decision aids improve care by informing patients and involving them in their own decision-making; in fact, research backs up this finding, time and time again. But the research also shows that these aids, despite their value, are not being used in everyday practice.

That situation is the process of changing at The Ottawa Hospital. The Ottawa Hospital Research Institute, affiliated with the hospital, is the centre for decision-aid development in the world. In fact, google "patient decision aid" and the website of the OHRI Patient Decision Aid Research Group shows up at the top of the list.

The group has developed an inventory of more than 200 aids in areas ranging from A (Alzheimer’s disease) to W (weight control) that are being used in countries around the world. Millions of people access the decision aids online every year. But despite their proliferation, use of these aids is "pretty hit and miss," according to Dawn Stacey, associate professor of nursing at the University of Ottawa and director of the Patient Decision Aid Research Group.

To promote and increase the use of decision aids, the research group is conducting two pilot projects – one in the area of joint replacement, the other in prostate cancer – to examine how to integrate decision aids into standard care delivery. In each case, participating patients are given a booklet and a DVD that summarize their care and treatment options, outline the pros and cons of all options, and allow patients to decide what is most important to them. Patients can enter their health information and choices using a touch-screen computer. From this, a one-page summary is generated and given to the patient’s surgeon. For example, in the case of prostate cancer, patients can decide which option – surgery, radiation or "watchful" waiting – best suits their values and priorities, with a clear knowledge of the risks, benefits and side effects of each option.


Physicians only have to be convinced to try using the aid once. After that, they’re hooked.


In the case of the joint replacement pilot project, patients who are found to be eligible for surgery through a screening process receive either the decision aid or the usual care. An evaluation of the use of the decision aid found that the aid improved both patient knowledge and the quality of decisions made.

Jamie Davison is one of those patients. The 54-year-old Ottawan had been dealing with severe knee pain for three or four years before she entered the screening program. She received the decision aid and found it "just excellent." She particularly appreciated how the aid brought together a wealth of information, all in one place. "Often we don’t even know the right question to ask," she says. "And if we did, where do you start to get the answers? It eliminated the need to follow all those different paths to gather information yourself." Davison also appreciated the non-judgmental approach in the decision aid. If it talked about the need to be physically active or lose weight, "I didn’t feel defensive, I just felt reminded."

Another benefit of the decision aid, Davison says, was having the opportunity to read and re-read. In the doctor’s office, she explains, you can’t ask the same questions over and over. And it’s not always easy to remember everything that was said. Davison’s view is backed up by research showing that it’s difficult for patients to remember oral conversations, particularly at stressful times such as when receiving a diagnosis. Decision aids are a key tool in patient

Changing perceptions

Patients certainly appreciate the aids. But convincing physicians and surgeons to make use of the aids remains a challenge. "The research shows that just because a patient uses a decision aid, it doesn’t mean that it has an impact on the discussion with the oncologist," says Stacey.

One of the barriers to use of the decision aids is the perception that they take too much time and don’t add value. Using decision aids doesn’t add time to the discussion, Stacey explains. What it does is change the dynamic of the discussion. Rather than spending time going over the risks and benefits of the various options, the discussion can focus on a patient’s values and priorities – what matters most to him or her. In fact, physicians usually only have to be convinced to try using the aid once, Stacey says. After that, they’re hooked.

Geoffrey Dervin is the head of the division of orthopedic surgery at The Ottawa Hospital. He’s been using the decision aids with patients for almost two years. He likes what the aid does for his meetings with the patient, saying they’re much more efficient. "Patients are more focussed in their questions," he says. "And their concerns jump off the page in the summary, so I can zero in on that and even ask pointed questions if they don’t bring it up."

In Dawn Stacey’s ideal world, patient decision aids would be used more broadly and on a regular basis. For now, though, she’s happy to start with joint replacement and prostate cancer – recognizing that the knowledge gained will eventually translate into increased patient involvement, in all aspects of care.

Contact:

Dr. Dawn Stacey
Associate Professor, University of Ottawa and Director of the Patient Decision Aid Research Group at OHRI
Dawn.Stacey@uOttawa.ca

This edition of Pass it on! highlights four Canadian healthcare organizations that are making the patient part of the healthcare team.

Other stories in this edition:

Disclaimer:

Pass it on! is a publication of the Canadian Health Services Research Foundation (CHSRF). Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit corporation with a mandate to promote the use of evidence to strengthen the delivery of services that improve the health of Canadians. The views expressed herein do not necessarily represent the views of the Government of Canada. © CHSRF 2010