Over the past decade, interest in empowering patients to participate in decisions regarding medical intervention (e.g., screening tests, drugs, surgery) has markedly increased. Institutions in the private and public sector agree that shared decision-making is a laudable objective. In spite of this rhetoric, straight-forward approaches to facilitate doctor-patient communication remain illusory. Primary objectives of the Center for Interpreting Health Benefits and Risks (IHBR) are: 1) to explain why this inertia continues to exist; and 2) advocate for the use of a practical, methodology designed to result in a high level of patient involvement.  We believe that the incorporation of shared decision making into all medical discourse will lead to a reduction of the cost of care and an increase in quality.

 

The IHBR Center has developed what could be viewed as a ‘universal’ decision aid called the Benefit Risk Characterization Theater (BRCT).  The BRCT is a simple graphic which, without statistics or medical jargon, enables doctors and patients to reach common ground (CLICK HERE to see examples from, Interpretation of Health Benefits and Risks: A Practical Guide to Facilitate Doctor-Patient Communication).  Our book is  a comprehensive guide as to how BRCTs can facilitate shared decision making and improve doctor-patient discourse.  The IHBR Center goes beyond what is in the book and offers to expand our concept and philosophy more broadly.

 

IHBR plans to provide advice and guidance on aspects of shared decision-making to: doctors; others in the medical community; the media; pharmaceutical companies; attorneys; health insurance companies; medical journals; patients; and others interested in this issue. Emphasis and focus will be placed on, but not necessarily be limited to, the following topics.  

 

• Facilitate Doctor-Patient Communication – The subtitle of our recently released book is: A Practical Guide to Facilitate Doctor-Patient Communication. As noted above, we have developed a practical, universal methodology which will allow patients to become legitimate participants in decisions regarding medical intervention. Our unique graphic has already been successfully used, on a limited basis, to enable patients to assess their own level of acceptable risk.  CLICK HERE to see the results of recent focus groups regarding the BRCT concept.

 

• Empower Patients – Emphasis continues to be placed on empowering patients. With the passage of Affordable Care Act (ACA), a new institute was formed (Patient Centered Outcomes Research Institute - PCORI) which funds projects designed to focus on patient involvement in decisions associated with medical intervention. Similar initiatives are being proposed by non-governmental organizations in both the private and public sector.  We believe that patient empowerment is essential for decreased cost and increased quality of medical care.

 

• Advocate for the Use of Absolute Risks – Currently, benefits and risks associated with medical intervention (i.e., screening tests, drugs, surgery) are almost always presented by using relative not absolute numbers. The use of relative numbers by pharmaceutical companies, the media and many in the scientific and medical community is ill advised and distorts information presented to patients. The use of absolute values is a prerequisite to meaningful shared decision-making. This is not a trivial concern and needs to be brought to the attention of leaders in the medical community.

 

• Reduce Overtreatment – It is becoming more and more apparent that patients in the US are ‘overtreated’. Overtreatment can result in iatrogenic consequences – damage induced by a physician or surgeon or by medical treatment or diagnostic procedures. Studies show that overtreatment leads to escalating cost and diminishing quality.  By definition, shared decision-making will lead to reducing deaths and injury associated with iatrogenic medical intervention, while also cutting costs and increasing patient satisfaction.

 

• Develop a ‘Universal’ Decision Aid – Decision aids are being used with greater frequency every year to assist patients in understanding the pros and cons of medical intervention. Theoretically, these aids can be of great value to patients and doctors alike. Unfortunately, the quality of existing decision aids is not uniform and, at the present time, there are no guidelines defining what criteria and/or standards constitute prerequisites for an appropriate aid.  We believe that the BRCT concept successfully bridges the gap between doctor and patient, and helps all organizations (including the media) convey medical information that is both accurate and clear.