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OBJECTIVE: Analyze the role of collaboration in the International Shared Decision Making organization (ISDM). METHODS: Case study of the seven year history of ISDM as a professional network. RESULTS: The International Shared Decision Making meeting Conference (ISDM) has held four biennial meetings since its inception in 2001. It is a freestanding professional meeting, with no permanent institutional support and no formal governance structure. In both its history and its prospects, collaboration among attendees has been pivotal to its growth. It both attracts and holds its 'members' through the strength of the relationships formed during and between meetings. Exchanges in ISDM are informational, collegial, and indirectly economic. CONCLUSION: ISDM's future rests on keeping all three functions healthy. It must maintain a focus on putting the shared decision making work first through becoming a 'worknet'. Technologies that promote shared decision making can then be assembled and developed that support transformation of health care. PRACTICE IMPLICATIONS: Innovative professional organizations need to develop their work through deliberate development of networking techniques to move innovation into practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: As part of a study of men's responses to a videotape decision aid [Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision aids for benign prostatic hyperplasia: applicability across race and education. Med Decis Making 2004;24:359-66], preferences for BPH treatment options were assessed. METHODS: One hundred and sixty men stratified by race and education completed a semi-structured interview that included assessments of treatment preferences. RESULTS: Most men initially and ultimately favored watchful waiting over other options, and 56.6% never changed their preference rank orders while viewing the videotape. BPH severity in context of treatment risk avoidance, efficacy, and expert opinion factors were frequently cited reasons for preference orders. Lesser education was associated with higher likelihood of changing preferences (r = -.30, p < .001), and percent increase in BPH knowledge pre- to post-videotape was weakly associated with fewer non-dominant preference shifts (r = -.19, p < .05). CONCLUSION: Conservatism regarding BPH treatment is moderated by context-specific factors, including new information. PRACTICE IMPLICATION: Counseling in a provider-patient partnership model should address both sources of variance in men's treatment preferences. [ABSTRACT FROM AUTHOR]

The objective of this project was to analyze newspaper coverage of the January 2000 meta-analysis by Gotzsche and Olsen, "Is screening for breast cancer with mammography justified?" [Lancet 355 (2000) 129]. A content analysis was performed on a comprehensive set of newspaper clippings from the UK during the 2 weeks following publication of the Lancet article. The original authors were most quoted in Wave 1 (the first weekend); the screening programme was most quoted in Wave 2 (week 2). Screening programme description, and the "quality" of the Lancet article dominated Wave 1; patient testimonials increased in Wave 2. Newspaper articles were structured as debates between experts and advocates, thereby enhancing polarisation of opinion. We suggest this is counter-productive to evidence-based patient choice and public involvement in decision-making. Medical journals' and charities' press releases that begin to include discussion of uncertainty inherent in medical technologies can contribute to evidence-based public deliberation. [ABSTRACT FROM AUTHOR]

How does the way that information is presented potentially influence patients' consent for health treatments, in a shared decision making process? The goal of this paper is to present an overview of selected recent literature concerning patient health information presentation/use for treatment decision making. Recent work with patient populations has begun to extend early cognitive psychological work showing systematic biases in thinking. Key research findings are organized by type of format (probability, graphic, and qualitative/quantitative dimensions). The applied literature on this topic is amenable to only limited integration in regard to key findings, and relatively few novel approaches to improving information comprehension have been described in the health literature. Promising approaches being proposed, developed, and tested are described, such as enhanced-access computerized patient choice modules, "debiasing" techniques, and tailoring of information. Additional theoretical and practical issues are discussed, as well as selected policy implications of current knowledge. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This paper describes the development and pilot testing of a communication skills curriculum based on medical student curriculum and modified for use with patients. METHODS: Six key concepts from our introductory medical education communication skills curriculum were identified. The core knowledge and skills related to these concepts were reorganized into six modules, including presentation materials, handouts and active learning components. The curriculum was pilot tested with three independent groups of non-medical participants, representing a broad cross-section of the community. RESULTS: Participants reported a high level of satisfaction; over 80% found the program helpful for learning new information and skills, and 92% for working with their physicians. Over 90% would recommend the program to others. Participant self-assessments revealed the greatest change in knowledge of medical interviewing. Skill changes were greatest in expressing emotion and efficiently telling the medical story. The pilot tests also highlighted the importance of other issues related to recruitment and health literacy. CONCLUSIONS: This project demonstrates that key concepts underlying doctor-patient communications can be simplified and repackaged for use from the patient's perspective. PRACTICE IMPLICATIONS: Similar curricula can empower patients from all walks of life to better communicate with their health care providers and enhance their healthcare experience. [ABSTRACT FROM AUTHOR]

Some instruments have been developed to evaluate 'decision effectiveness' such as the 'satisfaction with decision (SWD)' and 'decision conflict (DCS)' scales and are validated for the US context. Patients identify further outcome domains that are not fully covered in these scales. We developed a patient-based outcome measure to evaluate risk communication and decision making effectiveness, addressing these further domains and validated for use in the UK. Formulation of items was based on literature review and key informant interviews. The instrument was piloted and developed (including psychometric assessment) in the context of a trial of decision making and risk communication interventions in general practice. Patients were recruited to the trial with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms. High response rates (96% in first phase) indicated acceptability to patients. A 20 item patient-based outcome measure, with two sub-scales for 'risk communication' and 'confidence in decision', was produced. It allows for paternalistic, shared or informed choice decision making models. Usage in further studies will facilitate systematic reviews. Consequently, lessons for wider application of these interventions in practice, and policy implications regarding greater patient involvement should then be clearer. [ABSTRACT FROM AUTHOR]