1. Executive Series 1 Shared Decision-making: An Essential Resource for Patient-Centered Care Based on Science Alliance for Health Reform February 14, 2010 Helen Darling, President National Business Group on Health

2. 2 An Essential Tool Even More Important Every day, millions of Americans make choices that affect the quality and length of their lives, and their likelihood of survival and avoidance of serious disabilities and suffering. Most make those decisions with little, if any, information about the risks and harms of those decisions. They are usually informed about the benefits. As we have more and more evidence about how complex health and health care are, especially with expanding knowledge of genetics and disease complexity, the need is growing exponentially for thoughtful, careful assessment by patients, working with their doctors and with access to evidence through “shared decision-making tools.”

3. 3 We Have to Expand the Number of Tools For our employers and their employees and dependents, we are hoping that all research, including clinical trials and comparative effectiveness research (CER), will provide the information to inform patients, doctors and other health professionals about what they need to know to make the best decisions for each individual patient. We have many great examples already of when patient decision support tools are valuable. Within the broader, evidence-based guidelines, women have to decide when to have mammograms based on their own individual potential benefits, estimates of risks and possible harms. Women need to consider whether to take hormonal therapy at all and, if so, for how long.

4. 4 The Need Only Grows with Care Complexity Women may need to decide whether to have a radical mastectomy or lumpectomy and, based on last week’s newly reported study, the extent of lymph node surgery. Men need to decide whether to have a PSA and, if so, what to do if there are results that add to their uncertainty, not provide definitive answers. Some of the most overused procedures are also very risky and patients have to decide what risks they are willing bear for:  back surgery  hip and knee replacements  C-sections  episiotomies

5. 5 This is about better care for every patient Some of the most important values of shared decision-making and patient decision support tools are: 1)They remind people every day that they have a lot more control over avoidable risks and harms than they realize 2)They remind physicians, nurses and other health professionals that they have to provide a fair, objective, balance review of risks, benefits and harms for all treatment options. Without thorough review and the right conversation with patients, the reality of informed consent is shockingly inadequate.