Harder Than It Seems

Most practices have copies of handouts at the ready for for common diagnoses, and procedures for which careful patient preparation is required. Some have made this information available on line, as well, which can be particularly useful when the handout gets misplaced between the time it is given to the patient and the patient is ready to look at it.

It is another story, though, when it comes to the careful preparation and systematic distribution of information to support patient decision making. This is understandable given the explosive expansion in the quantity of scientific information being generated and the rapid pace of change in some many areas of healthcare. It is hard enough for providers to keep up with the information they need for their own decision making.

Despite the challenges, there are many examples of providers supporting patient decision making. For example, many urologists show a professional society video to patients considering whether or not to have a vasectomy. And oncologists, as a group, tend to give a good deal of information to patients about various options and about particular clinical trials in which they might want to consider participating. But a closer look suggests that providing patients with information which assesses options on the basis of solid, objective evidence concerning medium or long term outcomes and significant impacts on quality of life, is far from common practice, even in these areas.   

Supporting Patient Searching and Learning

It is possible to imagine the best of all possible worlds, where publishers would routinely make patient-friendly versions of journal articles available to providers for distribution to their patients, as a normal service provided to subscribers. However, in lieu of this, identifying good sources of patient friendly information on specific topics and encouraging patients to discuss what they learn with a member of the provider team may be the best option. Referral to patient support groups can be quite helpful, and can complement provider interactions.

Format of Handouts and Resources

It is helpful to have patient decision support materials available that are appropriate for those more visually oriented , or at a lower literacy level, or in languages spoken in the community. If possible, make resources available on tape for those who are visually impaired or find listening to be an easier way to take information in.

Phone Support One of the best ways to support patient-decision making is to provide time to talk the pros and cons of a decision through. The limited time available for the clinical encounter is frequently inadequate for this purpose, particularly when challenging, emotion-charged decisions need to be made. A supportive conversation with a trained clinical or non-clinical member of the provider team may be one of the most effective ways to support patient decision-making, and the strategy most deeply appreciated by patients. Such calls, like most follow-up or “check-in” calls, seldom need to be longer than ten or fifteen minutes in length precisely because they are focused on a single issue.   

What’s Preventing A Decision? 

Finally, it can be helpful, during a pre-appointment call or in a pre-appointment email, to touch base with a patient about any difficult decisions bearing on the patient’s condition, that have been discussed but are still outstanding. A simple inquiry as to whether or not the individual has reached a decision, and if the response is “No,” a brief exploration of what factors are preventing or impeding a decision, can help both patient and provider prepare for more productive interaction on this topic during the visit.