1. Decision Aids Enhancing the Patient Experience Annie LeBlanc PhD Wiser Choices Program Knowledge and Evaluation Research Unit

2. Disclosures Relevant Financial Relationships None Off Label Usage None

3. Our Decision Aids are focused on facilitating a conversation between health professionals and patients and thus designed as tools intended for use during the clinical encounter

5. Evidence synthesis Observations clinical encounter Designers Study team Patients advisory groups Clinicians Stakeholders Initial prototype Field testing Modified prototype Final Decision Aid

7. The Wiser Choices Program Statin Choice Decision aid

8. Acceptable to patients (OR 2.8) Improved knowledge (2.4/9) Improved risk estimation (OR 22) Decreased decisional conflict (11/100) Improved total trust (OR 2.6) Improved action (70% fewer Rx in low risk patients) Short-term adherence (OR 3.4) Weymiller et al. Arch Intern Med 2007

9. The Wiser Choices Program Aspirin Choice Decision aid

11. The Wiser Choices Program Osteoporosis Choice

12. Just as acceptable as usual care >75% MDs found helpful (+ 1 min to consultation) Improved knowledge (1.8/9) Improved risk estimation (~RR 2) No change in decisional conflict or trust Increased patient participation in choice (9%) Same rate of Rx (~50%) in low and high risk patients Adherence evaluation is pending Montori VM et al. Submitted

13. The Wiser Choices Program Diabetes Medication Choice Decision Aid

14. Glucose control in t2 diabetes No clear evidence for a goal HbA1c Comparative effectiveness data of safety 9 types of agents (+ lifestyle modification) Many attributes per agent

15. Mullan RJ et al. Archives of Internal Medicine 2009 more helpful (AMD 0.38; 95%CI, 0.04-0.72) improved knowledge (AMD 1.10; 95%CI, 0.11-2.09); and had more involvement in making decisions (AMD 21.8; 95%CI, 13.0-30.5) 6-mo perfect medication use (100% of days covered) better adherence (AMD, 9% more days covered; 95%CI, 4%-14%) persistence (AMD, 12 more days covered; 95% CI, 3-21 days) no significant impact on HbA1c levels (AMD, 0.01; 95%CI, −0.49 to 0.50)

17. Interactive Diabetes Cards

18. The Wiser Choices Program Other Wiser Choices Decision aids

19. Chronic care Depression Choice (AHRQ) Genomic Cardiovasular Choice Hypertension Rosiglitazone (Avandia)

20. Acute care Chest Pain Choice AMI Choice Periop Smoking

21. 13 Wiser Choices Decision aids Chronic & acute care Primary care & subspecialty & ER In/out patient settings Rural & urban communities >50 sites > 200 clinicians > 600 patients

22. Shared Decision Making National Resource Center Wiser Choices Program Knowledge and Evaluation Research Unit

23. Contributions Patient Protection and Affordable Care Act Develop & evaluate patient decision aids Define international standards Educate and train care providers Adopt and use decision aids at point of care Contribute to statewide implementation efforts

24. Internal Partners SDMNR Center One Voice Health Policy Center Center for Social Media Dept. of Development Center for Innovation Wiser Choices Program Patient Education Center MayoClinic. com Program in Prof. & Ethics AskMayo Expert

25. Center Website http://shareddecisions.mayoclinic.org http://shareddecisions.mayoclinic.org Blog Announcements (events) Resources Research News articles

26. Creating a conversation Evidence synthesis Translation of evidence into action Patient important research Design of care around the needs of the patient Improve value of healthcare to the patient Minimally disruptive medicine FIT Shared decision making

27. http://kerunit.e-bm.org http://kercards.e-bm.info http://shareddecisions.mayoclinic.org