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As a post-menopausal patient considers hormone replacement therapy, what potential outcomes carry the greatest weight a slightly increased risk of breast and ovarian cancer or a lower risk of heart disease and osteoporosis?
That is a decision patients must make themselves. But rather than relying on information from the lay media or material supplied by pharmaceutical companies, patients can learn about their personal risks and benefits of hormonal replacement therapy and treatments for a variety of other medical conditions with interactive videos.
The Shared Decision-Making Programs, produced by the non-profit Foundation for Informed Medical Decision Making in Hanover, NH, provide probabilities of good and bad outcomes based on the patient’s clinical information. The videos also provide evidence-based information and interviews with patients.
"[The programs] give patients a glimpse into the future if some of these outcomes occur after the choice is made," says Albert G. Mulley, MD, the foundation’s scientific director and chief of the general medicine division of Massachusetts General Hospital in Boston.
For example, with hormonal replacement therapy, "this isn’t really an answer science can provide," says Mulley. "The judgment about which trade-off makes sense for that particular women depends not on science but values and preferences."
The programs, which require a computer and laser disc player and cost about $1,000 a year each, address both acute and chronic conditions as well as long-term issues, such as advance directives.
The most popular interactive videos include benign prostatic hyperplasia, prostate cancer, breast cancer, and low back pain. (See editor’s note for contact and ordering information.)
Some health plans have reimbursed providers for the Shared Decision-Making Program because it enhances patient care, says Mulley. It also can save physician time, he says.
"If you believe that a patient ought to have the information they want about a fateful choice in their medical history, what is a more cost-effective way of doing it two hours with a breast cancer surgeon or an hour and 40 minutes with a Shared Decision-Making Program followed with 45 minutes with a breast cancer surgeon?" he asks.
Patients generally want information about their medical conditions and possible treatments. But does that information influence their choices? In a study of the Shared Decision-Making Program for ischemic heart disease, patients gained greater confidence in their treatment decisions after viewing the interactive video, which calculated long-term survival rates after undergoing bypass surgery, angioplasty, or medical treatment.1
The videos helped undecided patients choose a treatment alternative, but it didn’t lead patients to change their choices, says Elizabeth DeLong, PhD, co-director of the Duke University Medical Center outcomes research and assessment group in Durham, NC.
With the ischemic heart disease program, patients and physicians often make treatment decisions quickly, noted DeLong. "It’s very hard to find the time between cardiac catheterization and treatment to show the video," she says. "Something of this nature would be preferable before cardiac catheterization."
Giving patients more information and a greater say in their treatment decisions can increase patient satisfaction, says DeLong. "[Patients] feel like they’re more in control," she says.
[Editor’s note: For more information on the Shared Decision-Making Program, contact the Foundation for Informed Medical Decision Making, P.O. Box 5457, Hanover, NH 03755-5457. Telephone: (603) 650-1180. Fax: (603) 650-1125. E-mail: 2Share Decisions@Dartmouth.edu. Internet: http://www. dartmouth. edu/dms/cecs/fimdm/.]