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Challenging myths: Empathic decision making in usual clinical settings

Challenging myths: Empathic decision making in usual clinical settings. Victor M. Montori, MD, MSc KER UNIT, Mayo Clinic. Decision making models. Modified from Charles C et al. Desired clinical behavior EMPATHIC DECISION MAKING Partnership Dance across models. http://kercards.e-bm.info.

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Challenging myths: Empathic decision making in usual clinical settings

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  1. Challenging myths: Empathic decision making in usual clinical settings Victor M. Montori, MD, MSc KER UNIT, Mayo Clinic

  2. Decision making models Modified from Charles C et al

  3. Desired clinical behavior • EMPATHIC DECISION MAKING • Partnership • Dance across models

  4. http://kercards.e-bm.info Wiser Choices Program at Mayo Clinic’s KER UNIT

  5. Settings (bold = RCT)

  6. Statin Choice Weymiller et al. Arch Intern Med 2007

  7. Osteoporosis Choice Montori et al, AJM 2011

  8. Diabetes Medication Choice Mullan et al, Arch Intern Med 2009

  9. AMI Choice

  10. Chest Pain Choice

  11. Participants * Would like to use it again with other patients considering the same decision?

  12. Ethical Legal Success of the decision aid • Knowledge transfer • Creates a conversation • Fit Economic Effectiveness

  13. Implementation Understandable Doable Favorable Fit for purpose, users, setting http://normalizationprocess.org

  14. Statin Decision Aid

  15. Lessons learnt User-centered design happens in the field, takes multiple iterations and expertise. Testing decision aids in usual clinical settings is tough: decision moments are unpredictable. Repeated use for chronic decisions has been difficult to study in efficacy trials.

  16. Myths Goal and settings • Decision aids have no role in evidence-based care • Decision aids support shared decision making • Valid decision aids cannot be used in busy clinical settings, such as primary care Participants • Clinicians would not want to use decision aids – they are barriers to adoption of SDM • Acutely ill patients are not good targets for SDM • Elderly chronically ill patients cannot participate in SDM

  17. Summary of 5 years of work 13 wiser choices decision aids Chronic and acute care Primary and specialty care Rural, urban, and academic 50+ sites 200+ clinicians 600+ patients In trials!

  18. montori.victor@mayo.edu http://kerunit.e-bm.org http://kercards.e-bm.info http://shareddecisions.mayoclinic.org @vmontori

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