Minnier says she is a strong supporter of Centers for Medicare & Medicaid Services' reimbursements for goals of care conversations. "These conversations are not free and they are not easy. I'm glad CMS recognized the fact that talking to patients is as important as doing something to them," she says.
While NYU Langone and UPMC are focused on the emergency and intensive care departments, respectively, Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, is incorporating shared decision-making into the primary care and specialist settings.
Thanks to a "caring attitudes" grant from the Arthur Vining Davis Foundations, the nonprofit academic health system—which includes a main hospital, a children's wing, a cancer center, an association with the Geisel School of Medicine at Dartmouth, and community group practices—has created a pilot program through its Center for Shared Decision Making to foster better doctor-patient communication.
Through this Patient Support Corps Service Learning Program, volunteers (medical students and undergraduates from the nearby colleges as well as community volunteers) are trained in a technique developed by Jeff Belkora, PhD, at UCSF to assist patients in articulating their questions and concerns during a phone call ahead of an appointment. The volunteer then organizes the conversation into a concise one-page document for the patient and the physician to review in office.
"For instance, patients might ask if they can receive treatment locally, saving them an exhaustive trip," says Susan Berg, MS, program director.
Volunteers also accompany patients on their visit, recording the session so the patient can have improved recall of the visit. Berg says the program is getting a great reception from patients and clinicians, with one doctor relaying that a patient who had been scattered in her thoughts was able to clearly convey her concerns, leading to productive shared decision-making. In another case, a patient said she was worried about how trigger-thumb surgery would impact her art career. "The doctor might not have known to take that into consideration," Berg says.
Though the program currently is established in only a few departments, it is growing via patient request, and Berg says she hopes it will be available systemwide within five years.