On behalf of the planning committee, we are pleased to invite you to the 2012 Summer Institute for Informed Patient Choice. This year’s focus will be on measurement of decision quality and shared decision making in practice. There is a need for metrics for shared decision making and the use of patient decision support that are efficient, valid and reliable – and that have been adapted for use in clinical settings. We have carefully planned this year’s agenda to incorporate essential elements of health care delivery science. There will be two and one half days of didactic multi and interdisciplinary presentations by local, national and international innovators focused on this challenging area.

More information and registration can be found here

This may be helpful for those who are planning to submit workshop, symposia, exhibits, and oral and poster presentations to the 7th International Shared Decision Making Conference in Lima, Peru in June of 2013!

About ISDM 2011

I was impressed with the sheer variety of presentations at ISDM 2011 that I was able to listen to. (How aggravating when parallel sessions were equally desirable and one had to choose!)

I was struck by the contrasts of topic; of presentation styles; of national approaches both to working and their manner of delivering papers. This is inevitable in an international conference, but also stimulating and thought-provoking. I did wonder at the intensity and speed of delivery of some papers that were very `technical` in content, in sessions with more than one speaker from the same institution – leaving me with the feeling that they were communicating more with each other (and their questioners) rather than with and to the delegates generally, bearing in mind that there were many disciplines there as well as a contingent of lay people, all of whom who had come to learn presumably.

I agree with Tessa Richards view (BMJ blog):

Maybe they should have talked more about the potential of shared decision making to cut costs, reduce unwarranted variation in clinical practice, and improve the quality of care.

These are important considerations. Consideration of economic aspects is vital, particularly now.

I also agree with her comment that the messenger could partly be to blame:

Delegates pored over the reasons why shared decision making, which is widely seen as a cost effective intervention is not being mainstreamed in clinical practice. Could the messenger be partly to blame?

Above all, there is a need to ‘sell’  the concept, the philosophy, the ethos, as well as ‘talking amongst themselves’. Somewhat ironic to think that this could be construed as a failure to communicate outside of the meeting, or to identify to whom and how one ought to be communicating that shared decision making is today’s way of conducting consultations?

About ISDM 2013 and the road ahead

Perhaps some ‘softer’ presentations are needed in the next conference, perhaps exploring the rational/irrational aspects of decision making?  I did sometimes get the feeling that the apparently ‘irrational’ was not given enough room, but I believe it to be an important aspect in considering risk in decision making, and leading to a better under of the public/patients by clinicians/scientists.

Perhaps we should also take note of what Glyn Elwyn and colleagues wrote in the BMJ November 2010 following on from what Angela Coulter said, that UK patients rarely get the effective support to make their treatment decisions – one barrier being clinicians’ unwillingness to offer such support. Elwyn and colleagues said that much more research has gone into creating the decision aids themselves than into creating a culture where professionals espouse shared decision making as a skill and routinely use the tools. This echoes Tessa Richards’ sentiments.

‘Bridging that gap’ was what ISDM 6 sought to tackle. But I feel that more needs to be done to encourage all advocates of SDM to see that this problem is tackled better, to see that it is practised. It is likely that many clinicians think they understand what SDM is, but have, in fact, misunderstood to the point where they believe they are practising it, but are not.

Do the medical profession tend to take too much of the responsibility on themselves?

Perhaps more attention should be focussed on how clinicians can provide better encouragement to patients? As recommended in the Salzburg Statement, perhaps clinicians should be encouraged to do more to stimulate a two way flow of information; encourage patients to ask questions, explain their circumstances, and express personal preferences; and to provide accurate information about options and the uncertainties, benefits, harms, limitations and consequences of treatments and other interventions including screening.

There are situations when it is the patient who can at least try to stimulate a two-way flow of dialogue, thus taking the responsibility to achieve a better consultation with SDM. My little anecdote about my local experience is an example of that. And in this case, management was brought in to make it a three-way constructive and productive iteration.

I’m uncertain how much is taught about shared decision making to medical students but I`m sure Adrian Edwards and Glyn Elwyn will know the answer to that. I`ve asked my colleague at the University of Leicester, Professor Mary Dixon-Woods, about that. When I gave my invited lecture to the medical students there in May this year, I did talk about the Salzburg Statement and recommended that they read the BMJ of 9^th April 2011, holding up a copy for them to see.

Thinking of Lima

Thinking ahead to Lima, and the stated desire of the organisers to draw in more patient/citizen participants to the ISDM meeting next time, might it perhaps be possible to invite a joint presentation from clinician with patient, that would illustrate SDM in action in the research that is carried out to inform SDM?

The scientific committee has designated this meeting’s central theme to be:

Globalizing SDM: Pacientes @ the centre of healthcare.

The theme seeks to highlight that shared decision making is a key component of something more global, i.e., patient-centered care, and that its application is only relevant as part of a commitment to care for and about patients.

But also, in using different languages and a technological character, we also seek to highlight the notion that shared decision-making is currently an opportunity afforded at best to very few patients, mostly in high-income countries, and in these, those who are fortunate to have access to outstanding patient-centered care. Thus, our area of inquiry and activity, much to our chagrin, can increase disparities in healthcare that seem so contrary to our values. Furthermore, there are cultural and contextual factors that ought to be understood in order to successfully involve patients in decisions about their care.

In ISDM Perú 2013, we invite investigators and concerned partners in healthcare delivery research and practice to struggle with the issues that arise as shared decision making globalizes in scope (as a component of patient-centered care) and spread (as a component of healthcare everywhere for everyone).

Lima is a dynamic metropolis at sea level, the jewel of South America, illustrating its opportunities and challenges. Our meeting location in Lima will enable us to network, learn, and enjoy each other in a safe and exciting environment in which every detail will be considered.

We will ensure that you will have unparalleled opportunities to enjoy Peru’s rich cultural heritage, marvelous food, and engaging music.

The experience is like none other – as these “Peruvians” from Peru, Nebraska, US found out when the Peruvians from Peru came to visit!

And the time of the year is perfect to travel the country, including the best time of year to visit Cuzco (the capital of the Inca Empire) and Machu Picchu, a UNESCO World Heritage Center.

Safe the date – June 16-19 2013 and mark your maps. The journey to globalizing shared decision-making – towards patient centered care for all – begins now. See you there!

Machu Picchu turning 100 years old (CC) Bruno Furnari

The Organizing Committee – ISDM Perú 2013

Mayo Clinic: Annie LeBlanc, PhD (Chair, Scientific Committee), Victor M. Montori, MD (Chair, Conference), Nilay D. Shah, PhD, Claudia Tabini (Chair, Social Committee)

Perú: Germán Málaga, MD (Universidad Peruana Cayetano Heredia).