AlignMap

Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

AlignMap header image 2

Patients’ Tool Improves Treatment Decisions, Adherence

May 30th, 2007 at 7:21 am · · Decision-Making · No Comments

Patient-specific Qualitative Data Made Understandable

Sample Patient Decision Aid For Low-risk Patient (click to enlarge)

The Statin Choice Tool

The Statin Choice Tool was developed as part of the The Wiser Choices Program,1 which was itself created at the Montori Lab of the Mayo Clinic.

The Wiser Choices Program is described in this excerpt from the Mayo web site:

The Wiser Choices Program is currently focused on the design, development and formal testing of patient-centered and evidence-based decision aids in clinical practice. These tools can help clinicians convey information to patients that will enable decisions that are both consistent with the best available evidence and with the values and preferences of the informed patient. Thus far, our work has shown that we can improve action (medication starts) and adherence (medication use) by involving patients with diabetes in the decision to use statins.

These decision aids present evidence-based estimates, specific to a given patient, of the potential benefits and disadvantages of the available treatment options in straightforward language augmented with graphical representation of statistical findings (see image atop this post). The interlinked goals are to involve the patient in the decision-making process in a meaningful way, improve the acceptability of the treatment decision to the patient, enhance adherence, and improve the clinical outcome.

Commentary

Making decisions about treatment is a difficult process, even if one buys into the premise that such decisions should be based on research-based evidence.

Healthcare professionals themselves often misinterpret statistical findings; a patient who lacks training in statistics, research, and the pathology and treatment of his or her disorder can hardly be expected to be immediately capable of making a choice in his or her own best interest. Educating such a patient can be an arduous, time-consuming task for the patient and clinician, especially since the effort must be accomplished when the patient is under stress.

Complicating the situation is the concern that the clinician will exert undue influence on the patient, rendering the patient’s role in that decision a sham. Some bioethicists would hold that a physician should lay out the patient’s treatment options with each choice’s risks and benefits, carefully abstaining from any indication of a preference for one or another, even if the patient requests that information. Others contend that such a mechanical process belies the human relationship between patient and clinician and robs the patient of the professional’s expertise.

The Wiser Choice Program and its Statin Choice Tool are attempts to efficaciously convey essential information about treatment to the patient in such a way that the patient’s role in determining treatment is legitimate and meaningful.

Tomorrow’s post will focus on a recently published study designed to determine if the Statin Choice Tool accomplishes that goal.

end3

Update: Statin Choice Tool Clinical Trial

__________
  1. Further information about the Wiser Choices Program, including this documentation:

      * Statin Choice Instruction Manual for Providers
      * Statin Choice Decision Aid Informational Booklet for Patients
      * Case 1 – High-Risk
      * Case 2 – Mid-Risk
      * Case 3 – Low-Risk
      * Pen-and-paper coronary risk estimator based on the UKPDS

    can be found at Mayo Research

Tags: Decision-Making