“The best interest of the patient is the only interest to be considered”
This last sentence is from the 1910 Rush Medical College commencement address by W. J. Mayo, M.D. The full sentence included an important requirement:
“in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.”
The Shared Decision Making National Resource Center represents a union of forces with breadth and depth of capabilities that does not have parallel anywhere in the world. Furthermore, the Shared Decision Making National Resource Center is involved in setting international standards for patient decision aids, state-wide shared decision making practices through the Minnesota Collaborative on Shared Decision Making, and promoting national and international dialogue about patient-centered care. The partnerships are best reflected in the composition of the initiative’s distinguished Advisory Board.
Together, 100 years after the “union of forces” address, Mayo Clinic is realizing this vision to promote a true patient revolution in healthcare, one that brings healthcare back to the patient’s best interest, which is the only interest to be considered.
Patients and clinicians have different expertise when it comes to making consequential clinical decisions. While clinicians know information about the disease, tests and treatments, the patient knows information about their body, their circumstances, their goals for life and healthcare. It is only collaborating on making decisions together that the ideal of evidence-based medicine can come true. This process of sharing in the decision-making tasks involves developing a partnership based on empathy, exchanging information about the available options, deliberating while considering the potential consequences of each one, and making a decision by consensus. This process — sometimes called patient-centered decision making, empathic decision making, or shared decision making — demands the best of systems of care, clinicians, and patients and as such remains an ideal. To make patient-centered decision making happen in practice, the Wiser Choices Program at the Knowledge and Evaluation Research (KER) Unit at Mayo Clinic has prioritized helping clinicians share information about the options and their consequences through the use of decision aids during the clinical encounter. The goal of this program is to identify and evaluate ways to help patients make well-informed decisions that reflect their values and goals with their clinician. Decision aids–tools to share information and create a conversation about the options and their relative merits and downsides — have been designed in a user-centered way and developed by the Wiser Choices Program. These have been tested in randomized trials in usual clinical settings and they comply with the latest IPDAS standards.
Like all the research conducted at the KER Unit, the Wiser Choices Program is funded through foundation or federal grants, and not from for-profit healthcare, pharmaceutical, or device companies. Users are free to apply these decision aids in their practice and for noncommercial purposes (e.g., teaching, training) and should let us know about their experience. These decision aids facilitate conversations between healthcare professionals and patients and thus are designed as tools intended for use during the clinical encounter. These decision aids should not be used as the sole source of information for patients and should not be used by patients independently.