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Shared Decision Making in Health CareAchieving evidence-based patient choice$
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Glyn Elwyn, Adrian Edwards, and Rachel Thompson

Print publication date: 2016

Print ISBN-13: 9780198723448

Published to Oxford Scholarship Online: September 2016

DOI: 10.1093/acprof:oso/9780198723448.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 22 October 2021

Case study

Case study

Changing culture and delivery to achieve shared decision making at Dartmouth-Hitchcock Medical Center, New Hampshire

(p.204) Chapter 31 Case study
Shared Decision Making in Health Care

Alice O. Andrews

Stephen A. Kearing

Dale C. Vidal

Oxford University Press

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.

Keywords:   Decision support, implementation, decision aids, shared decision making, culture change, patient-reported outcomes

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