The Patient's Toolbox for Better Decision Making

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Although it can be advantageous to discuss evidence-based medicine and quantifiable benefits and risks of treatment, physicians have to remember to take into account patient preferences.

At Patient-Centered Diabetes Care held April 16-17 in Boston, Massachusetts, Patrick J. O’Connor, MD, MA, MPH, senior clinical investigator at HealthPartners Institute for Education and Research and clinical associate professor or family medicine and community health at the University of Minnesota School of Medicine, kicked off the meeting with a discussion communicating treatment information to patients.

“How do we inform patients so that they’re treatment preferences are somehow connected to the reality of the benefits and risks that may be involved?” he posited “And how do we communicate that information to patients in a way that is comprehensive?”

When assessing a patient’s motivation and willingness for treatment, it’s important to understand a few things about the individual: does the patient actually believe he or she has diabetes; does the patient understand diabetes is serious; and does the patient believe good care will make a difference?

In addition, the provider has to determine the best way to present data to the patient. There are a few ways to do this, and some are more successful than others. For instance, mailing personalized information including the patient’s A1c and low-density lipoprotein levels is proven not to work. A trial found that patients receiving these types of letters with their information and asking them to visit their doctor actually had worse A1c and fewer visits at the end of the trial.

“We didn’t ask these patients what they want,” Dr O’Connor explained. “We didn’t ask them anything about their treatment preferences… It’s not customized to their treatment preferences or priorities, it doesn’t address the issue of do they really believe they have diabetes, do they really think it’s serious, and do they think that more intensive treatment will help.”

The tactic that Dr O’Connor has had success using is a system that runs patient information through an algorithm and provides it back to the patient in an easy-to-read format. In what he calls the “Netflix approach” the patient receives a document with a checkmark next to the things he or she doesn’t have to worry about and exclamation points next to those that need more work. This approach points out what is or isn’t at goal and what has the greatest potential to reduce the patient’s risk of a heart attack or stroke if they take some recommended steps.

“It’s really important when you have someone with diabetes to be patient-centered in the care,” he said. “And if you want to be patient-centered in the care, a good way to find out where to start is to figure out how the person thinks about diabetes.”