Health News Review

Patient communication has room to grow,” reported Reuters Health.  And so does journalism about shared decision-making or patient-centered care – subject of four papers and an editorial in this week’s JAMA Internal Medicine.

Respondents reported much more discussion of the pros than the cons of all tests or treatments; discussions about the surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening. Most patients (60%-78%) said they were asked for input for all but 3 decisions: medications for hypertension and elevated cholesterol and having mammograms (37.3%-42.7%). Overall, the reported decision-making processes were most patient centered for back or knee replacement surgery and least for breast and prostate cancer screening.

Discussions about these common tests, medications, and procedures as reported by patients do not reflect a high level of shared decision making, particularly for 5 decisions most often made in primary care.”

There was wide variation in the framing and completeness of the stories we saw about these journal articles.

Reuters Health was the most complete of the stories we saw, addressing at least briefly each of the four journal papers and the editorial.

The Los Angeles Times focused only on cost, “Patients who helped with medical choices had higher bills.” It reported on only one of the 5 articles in the journal. Why? Were the national survey and the other papers and the editorial not worthy of at least a line? also reported only on the cost article, “Shared decisionmaking may spur higher costs, longer hospital stays.“  But the article did include this independent expert quote:

“If an organization engages in shared decisionmaking to look good, make more money, save money or improve outcomes, they may be disappointed,” Dr. Victor Montori, director of the Health Care Delivery Research Program in the Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minn., said in a January e-mail. “Shared decisionmaking is a manifestation of your commitment to the patient.”

And it at least quoted the editorial writer:

“But Dr. Mack Lipkin, professor of medicine at New York University and an attending physician at Bellevue Hospital, New York, found fault with the latest study’s conclusion, arguing that patient preferences were subtle and nuanced, and not able to be captured accurately by a single survey question.

“Their methods leave me uncertain as to what is actually being measured,” said Lipkin, who wrote an accompanying commentary in the journal. “What people say on a questionnaire and what they prefer are not the same thing. When patients and doctors agree, there’s more likely to be a coherent plan and adherence to treatment, and that is likely to reduce costs.”

It would have been better (and not difficult) if the LA Times and Modern Health Care had simply posted links to the other papers – on the same topic in the same journal – as I did above.

Meantime, where were all the other news organizations on this topic?  On a holiday when you’d think they would have been scrambling for news.  This one was gift-wrapped and dumped in their laps, and many still didn’t respond.

Update two hours later:

HealthDay also focused only on costs, “Involving Patients in Decisions Raises Health Care Costs, Study Finds.”

So did, “Time is Money: Patient Involvement in Medical Decisions More Costly Than Letting Doctors Call The Shots.

Addendum on June 1:

Dave deBronkart (e-patient Dave) blogged, “When Bad Heads Go Viral: How A Malformed Headline Is Skewing Our View Of The Patient’s Role In Medicine.”


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Jessie Gruman posted on May 28, 2013 at 2:45 pm

Excellent observations, Gary.

It is endlessly frustrating that the few articles JAMA Int Med publishes that would be of great interest to patients / advocates are obscured by the JAMA pay wall. Only one abstract page had sufficient information to be worth tweeting to the patient community today (survey). Hits especially hard given the skewed press coverage as noted by Gary.

Gary Schwitzer posted on May 28, 2013 at 4:04 pm

I sent a link to this post to the Shared@EACH – Shared Decision Making Network Facebook page.

Dr. Victor Montori of the Mayo Clinic responded: “I was actually surprised Archives published these papers. Surveys of SDM are not adequate and people tend to like them. Since almost no one experiences SDM, how can they have expectations or opinions about it?”

And Paul James Barr of the Dartmouth Center for Health Care Delivery Science’s Preference Laboratory wrote: “We’ve case a critical eye over them in the Preference Laboratory too!”

Steven Kussin MD FACP posted on May 30, 2013 at 2:04 pm

The thing about the JAMA study on Shared Decision Making on hospitalized patients misses the main fact. It’s like the old Jewish idea of giving penicillin to a dead man. “It won’t hurt; it can’t help…it’s just too late.” Same for hospitalized patients…Shared decisions are impossible in the hospital. Patients are so fearful and dependant in the face of active problems, they will lie down and sign up for anything. If the Shared Decision process preceded hospitalization then many would avoid the visit altogether

Casey Quinlan posted on May 31, 2013 at 7:19 am

Constructing this study as a post-discharge inpatient survey was the equivalent of putting a thumb on the scale. I don’t know if the goal was the skew the results to prove SDM won’t control costs, or if the point was to prevent pesky patients from attempting to participate in their care by “proving” that participatory medicine is more expensive to the system, or if the folks who designed the study were just clueless. Steven’s statement rings true: “If the Shared Decision process preceded hospitalization then many would avoid the visit altogether.” And as the Mayo Clinic doc says, since no one in the study actually experienced SDM, how can their input count as a measure of it?