Changing culture and delivery to achieve shared decision making at Dartmouth-Hitchcock Medical Center, New Hampshire
Early decision aid studies described in the Cochrane Collaboration, and implementation projects including the Dartmouth-Hitchcock Medical Center (DHMC) Spine Center suggest that shared decision making (SDM) reduces unwarranted variation in patient care. This chapter describes the creation of a Center for SDM to facilitate the redesign of care pathways, distribution of patient decision aids, personalized decision support, and patient-reported outcome measures. Details on how the center supports care pathways for breast and prostate cancer, spine, hip/knee osteoarthritis, and primary care are presented. Successes include the distribution of more than 36,000 patient decision aids, SDM training for hundreds of clinicians and staff, and clinical care that incorporates systematic patient decision support. While the right tools and processes are positive first steps, sustainable SDM requires culture change and new patterns of communication between patients and providers.
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