Dancing with Care

There was an interesting exchange recently on Facebook group Shared @ EACH – Shared Decision Making Network in response to  Greater Choice and Control- a response to UK Department of Health consultation by Theo Raynor, Professor of Pharmacy Practice at the University of Leeds and Director of Luto Research Ltd, which provides patient information testing services. In the exchange,  E-Patient Dave deBronkart and Dr. Victor Montori discuss “the art of dancing with care.”

What shared decision making means to the patient

With shared decision making, patients have the opportunity to discuss their lifestyle and preferences with their physician (or nurse practioner or physician assistant) to make healthcare decisions that are right for them.  This can be especially beneficial to patients with chronic conditions.  In these videos, two Mayo Clinic patients share their personal experiences with shared decision making and how it has changed the management of their own health. 

Minnesota Shared Decision Making Collaborative

Written by: Annie LeBlanc, PhD, Research Fellow with the Knowledge and Encounter Research Unit at Mayo Clinic

The Minnesota Shared Decision Making Collaborative hosted, in collaboration with Health Partners, a one-day conference on Optimizing Shared Decision Making in Health Care. Their effort to gather healthcare providers, patients and policy makers interested in Shared Decision Making was well received as there were around 70 attendees.

Internationally recognized speakers and local experts shared their experience on Shared Decision Making and its implementation in practices and then engaged the audience in discussion around the place and future of Shared Decision Making in Minnesota’s communities.

Their take home message:

Practice: Make Shared Decision Making a habit by practicing everyday;

Facilitate: Facilitate Shared Decision Making by (i) making explicit the decision to be made, (ii) providing balanced information about options, (iii) asking patients what matters most.

Process:  The implementation of Shared Decision Making, facilitated by patient Decision aids, in both primary and specialty may be at least a partial solution to the problems of poor decision  quality and unwanted practice variation in the United States.

Succeed. A daily, communitiy-wide effort is our best chance to make Shared Decision Making a National success

Educational resources for patients

Mayo Clinic patients have access to a broad array of healthcare education and counseling services through the Barbara Woodward Lips Patient Education Center, which enables them to be partners in their health care.   The Center makes efforts to reach diverse audiences, as seen in its new design for teen patient education material. 

In this video, patients and staff discuss the Barbara Woodward Lips Patient Education Center:

The value of an unhurried conversation

by Victor Montori, MD (Wiser Choices Program)

As we reflect on the present and future of healthcare, it is key to consider the value of an unhurried conversation.

At the Mayo Center for Innovation 2009 Symposium, Maggie Breslin made a compelling case to focus on conversations as a key strategy to improve healthcare.  Watch her inspiring and inspired proposition here.

Becca Camp, a visiting student at our KER UNIT, recently wrote a blog post of an experience at Mayo Clinic she was privileged to witness.  In it she noted the relationship between an unhurried conversation and the opportunity to contextualize care to a patient’s specific situation, a requirement of both evidence-based practice and patient-centered care.  A recent rigorous and careful study documented how failure to pay attention to context can lead to poor quality care.

Don Berwick in his address to the Yale Medical School 2010 Graduating Address, he noted the critical importance of patient-centered care and the role that clinicians can play in treating patients with respect and humanity, urging them to

…recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul.

Meantime, we seek to measure value in healthcare and we find it difficult to articulate how to capture the value of the unhurried conversation.  How do we know that our systems promote these conversations?  Should we protect these, and if so how, when economic considerations (payment, demand, access) threaten them?

The unhurried conversation, a key component of the Mayo Model of Care, should be the focus of intense investigation.  How much time is necessary to achieve this experience?  How should care professionals be trained to participate?  How do new requirements for healthcare provision affect these?

I believe it will be up to patients — thru a strong patient movement — to make sure the unhurried conversation remains a possibility as healthcare changes.  And it will be up to us to provide the resources and knowhow to realize that possibility.