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Mayo Clinic creates a decision aid tool to improve patient-physician communication.

Providers increasingly want patients to be more involved in their care. Physicians, for example, might instruct their diabetic patients that if their Hemoglobin A1c levels are elevated, they need to take a different medication. A doctor may even hand a patient a 12-page pamphlet with more information regarding their disease and treatment options. But in many cases, the patient isn’t really involved in the process of choosing which medication is best for them—leaving them with a limited understanding of why it is important to take that medication. So if the patient has a negative side effect or if the prescription is too expensive, he or she may simply stop taking the medication or forgo filling the prescription in the first place.

People have tried to retrain how physicians communicate with their patients, but that has proven to be problematic, says Victor Montori, MD, an endocrinologist at Mayo Clinic. "How people communicate is a personality trait or style, and people are unlikely to change those," he says. So Mayo Clinic’s Knowledge and Encounter Research Unit developed a decision aid that includes a script for physicians and brightly colored, graphically designed flash cards for patients to use when discussing their treatment options with their doctor.

Mayo hired communication designers from Iowa State University who could look at the way people interact and then modify that interaction to enhance the value of the tool, says Montori. Mayo also involved its patient advisory group and clinicians who were interested in cholesterol medication and diabetes—the topic area of the first study.

"The majority of healthcare interventions are developed in a vacuum," says Montori. Traditionally, healthcare organizations would create patient education tools by gathering a bunch of clinicians together to determine what needs to be communicated to patients and how it should be communicated. "I am not entirely sure that they would have come up with this, and they likely wouldn’t have engaged patients in the development phase," he says.

Mayo generated rough prototypes based on input from the design researchers, patients, and clinicians. Because the decision aid was low-tech and there was no information technology involved, researchers were able to quickly test the tool and modify it until it was ready for a formal study.

Both physicians and patients liked the tool, but, more important, patients knew more about the risk of heart attacks and diabetes and how cholesterol medications could reduce those risks, says Montori, who was the lead researcher behind the study. The study found that 84% of patients were satisfied with the decision aid tool, there were 70% fewer prescriptions for cholesterol medication in low-risk patients who received the decision aid, and after three months, patients were three times more likely to adhere to their medication protocol.

Patients also get to keep a copy of the cards. "When patients get home they may find that implementing their choice was not what they thought," Montori says. "Well, they now have the cards in front of them and can figure out what should be their next approach. The phone call with the physician is then much more streamlined."

Carrie Vaughan

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