Shared decision-making programs: a descriptive analysis of experience with shared decision-making programs in VA. A systematic review: assessing the effectiveness of shared decision-making programs for prostate care
Record ID 31998008427
This report was prepared in response to a request from VISN 10 to the Management Decision and Research Centre (MDRC) Technology Assessment (TA) Program to provide information about Shared Decision-making Programs. SDPs are patient education videos designed to provide tailored, unbiased information about the benefits and risks of alternative treatments for selected disorders. The TA Program obtained information from expert opinion and published evidence to address the following questions:
1. Are Shared Decision-making Programs in use within VA?
2. Are the programs well suited to the clients served by VA?
3. How effective are Shared Decision-making Programs for prostate disease?
Authors' results and conclusions:
VA experiences with Shared Decision-making Programs (SDPs):
Anecdotal evidence from interviews suggests that SDPs are currently in limited use within VA, and are very well received by VA patients who have viewed them.
Implementation across VA sites varies widely.
VA has been actively involved in the creation and assessment of some SDPs.
Effectiveness of SDPs for prostate care:
Benign Prostatic Hyperplasia (BPH) - Compared with controls, patients who viewed the SDP responded favourably, felt they had better health and physical functioning, were markedly more knowledgeable about prostate disease and the risks and benefits of treatment options, and were more satisfied with their decision-making process.
Prostate-Specific Antigen (PSA) - Patients who viewed the SDP were more knowledgeable about prostate cancer, less likely to plan to have PSA screening in the next 2 years, and in fact did have significantly less screening.
Prostate Cancer - No published reports of the prostate cancer SDP were identified, although trials are underway. Preliminary results suggest that viewers of SDPs tended to favour less screening and less surgery for prostate cancer than non-viewers.
Published evidence and experiences within VA suggest that SDPs support patient involvement in care, are well received by patients, and can be used with a wide range of patients. SDPs provide one element of an outcomes-focused service in health care; their methods and goals are well aligned with those of VA. Limited evidence exists to demonstrate the impact of SDPs on treatment preferences for prostate care. Further research, using large, rigorously designed studies, is needed to assess their long-term impact on the cost and quality of care.
English language abstract:
An English language summary is available
- Prostate-Specific Antigen
- Prostatic Hyperplasia
- Prostatic Neoplasms
- Videotape Recording
- Patient Education as Topic
VA Technology Assessment Program
Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;
U. S. Department of Veterans Affairs, 1997