Electronic shared-decision tool may open up patient-provider dialogue

Getting patients and providers on the same page about treatment is a historically difficult prospect. Instead of outdated and lengthy paper pamphlets, an international team developed an interactive, evolving e-tool to facilitate conversation and reduce disconnects between physicians and patients.

The research team led by Thomas Agoritsas, MD, of the Department of Clinical Epidemiology and Biostatistics at McMaster University in Hamilton, Ontario, found in an analysis of current decision aids that many are insufficient and no decision aid guaranteed shared decision-making. Most were too long or out of date and did not provoke conversation between physicians and patients.

They noted physician’s lack of education on patient communication skills likewise wasn’t helping clinicians get points across to patients. Their findings, in line with other recent studies, found that physicians weren’t communicating clearly with patients and decision aids weren’t adequate to the challenge of filling in patient gaps about shared decision-making.

To attempt to resolve part of this issue, Agoritsas et al wrote that appraisal tools should help, including the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The MAGIC (Making GRADE the Irresistible Choice) app, for example, allows users to use GRADE to assess self-written guidelines and evidence summaries and allow them to be published in a web platform.

Agoritsas et al also developed their own aids as part of the SHARE-IT project, assisted by the MAGIC app. They built their 10 decision aids on antithrombotic drugs to be dynamic and interactive, finding this approach improved patient satisfaction through 16 encounters with their prototype.

They designed their tool to allow the physician to invite conversation between physician and patient, Agoritsas said in a press release. "[Y]ou both sit down in front of the tablet and you dive in and talk about what's most important to the patient first." Physicians asked questions and encouraged patients to ask their own.

"The process should be more about the discussion you have with your doctor and about enhancing the conversation, not overwhelming patients with too much information. It's less about showing the evidence than showing it in a way that it becomes a discussion," said Agoritsas. They found that when physicians asked the right questions, it generated more interaction with patients and allowed patients to ask questions and make decisions about their own care.

Going forward, the team planned the development of other scenarios to test and refine their tool for a variety of clinical settings and patient groups.

Agoritsas and colleagues published their findings Feb. 10 in the British Medical Journal.