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Cost information enhances shared decision making: lessons from FAIR Health's shared decision-making initiative
Cost information enhances shared decision making: lessons from FAIR Health's shared decision-making initiative
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Brief (FAIR Health, Inc.)
- Contributor(s):
- FAIR Health, Inc., issuing body.
- Publication:
- New York, NY : FAIR Health, Inc., December 10, 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Decision Support Techniques
Decision Making, Shared
Health Care Costs
Palliative Care
United States - Genre(s):
- Technical Report
- Abstract:
- Shared decision making (SDM) involves patient-clinician communication to decide on tests, treatment and care based on clinical evidence, balancing risks and outcomes with patient preferences and values. To accomplish SDM, evidence-based strategies and patient materials called decision aids (DAs) are often used. SDM shows promise for reducing unnecessary healthcare spending and costs, and for improving decision making without adverse effects on clinical outcomes. It is particularly applicable in scenarios involving preference-sensitive conditions (those for which the clinical evidence does not clearly support one treatment option and the appropriate course of treatment depends on the values or preferences of the patient) and those involving palliative care decisions for serious illness. Despite the evidence of SDM's value, its adoption has not been widespread. In April 2019, the Board of Directors of The New York Community Trust (The Trust) approved a grant to FAIR Health to implement an 18-month SDM-Palliative Care program. On March 10, 2020, with support from The Trust, FAIR Health launched an SDM feature with cost information at fairhealthconsumer.org (FAIR Health Consumer) to aid patients residing in the greater New York metropolitan area who have serious illnesses and are facing palliative care decisions, and their caregivers. Targeting adult patients (18+ years of age) in the greater New York area and New York State who are in palliative care situations and their caregivers, FAIR Health's initiative involved pairing cost information with DAs for a set of palliative care scenarios on FAIR Health's award-winning, free consumer website, FAIR Health Consumer, for the following options: (i) staying on or stopping kidney dialysis for end-stage renal disease, (ii) pursuing different nutrition options when swallowing is difficult and (iii) staying on or removing a breathing machine. FAIR Health successfully publicized the feature through diverse channels, including social media, digital media and FAIR Health's newsletters, as well as through outreach to organizations and clinical experts who serve palliative care patients and their families. The SDM section on FAIR Health Consumer received over 40,000 unique visitors nationwide in the first six-and-a-half months since it launched. FAIR Health presents salient program learnings in this brief to help inform current and future shared decision-making initiatives, whether focused on palliative care or other clinical areas. Among the lessons learned: (1) Conversations surrounding cost in palliative care enhance decision making. Based on conversations with palliative care experts, cost information provides an additional layer to the information presented about clinical treatment options. (2) Utility and value of SDM tools. Based on the qualitative insights and quantitative results we collected, providers and consumers alike deemed the SDM tools useful and valuable to SDM conversations in palliative care scenarios. (3) Acceptability of the SDM tools and appetite for additional tools. The acceptability of the SDM tools to both providers and consumers--and an appetite for additional SDM tools--were highlighted by the qualitative and quantitative data we collected over the program period. (4) Provider acceptability of SDM tools is a critical pathway for promoting SDM. Confirming the literature findings that providers are critical for SDM initiatives, our findings further suggest that clinicians welcome the guidance of SDM tools when having difficult SDM discussions. Early results point to acceptability of DAs among consumers; it nevertheless appears that providers, at least in the palliative care space, are also an important conduit for promoting shared decision making. (5) Need to improve awareness of SDM and patient DAs among providers. Despite some awareness of SDM as an approach to clinical practice, the idea did not appear to be very familiar among palliative care providers.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (9 pages)).
- NLM Unique ID:
- 101774941 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101774941