Interactive Video Assists in Clinical Decision Making

Abstract

The Hawaii Quality and Cost Consortium began a project in 1993 to implement and evaluate interactive videodisk programs to assist in clinical decision-making for breast cancer. Communication problems between physicians and patients, limitations of available outcomes data and varying preferences of individual patients can result in treatment outcomes that are less than satisfactory. Shared Decision-making Programs (SDPs) were developed by the Foundation for Informed Medical Decision Making (FIMDM) in Hanover, New Hampshire, to assist in the treatment decision-making process. Utilizing interactive videodisks, the programs provide patients with clear, unbiased information about available treatment options. With this information, patients can become more active participants in making treatment decisions. The SDPs for breast cancer were implemented at two sites in Hawaii. Evaluation data from 103 patients overwhelmingly indicate that patients find the programs clear, balanced and very good or excellent in terms of the amount of information presented and overall rating.

Keywords

Breast Cancer - Decision-making

• REFERENCES

• 1 Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989; 27: 110-27.
• 2 Eddy DM. Clinical decision-making from theory to practice: the challenge. JAMA 1990; 263: 287-90.
• 3 Mulley AG. The patient's stake in the changing health care economy. In: Technology and Health Care in an Era of Setting Limits. Gelijns AC. ed. Washington, DC: Washington National Academy Press; 1992
• 4 Wennberg JE. Dealing with medical practice variations: a proposal for action. Health Affairs. Summer 1984: 6-32.
• 5 Wennberg JE, Mulley AG, Hanley D, et al. An assessment of prostatectomy for benign urinary tract obstruction. Geographic variations and the evaluation of medical care outcomes. JAMA 1988; 259 (20) 3027-30.
• 6 Perrin JM, Homer CJ, Berwick DM, Woolf AD, Freeman JL, Wennberg JE. Variations in rates of hospitalization of children in three urban communities. N Engl J Med 1989; 320 (18) 1183-7. (See Comments N Engl J Med 1990; 322 (3): 206-7.
• 7 Cleary P, Greenfield S, Mulley AG, et al. Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA 1991; 266 (1) 73-9.
• 8 Wennberg JE. Physician uncertainty, specialty ideology, and a second opinion prior to tonsillectomy. Pediatrics 1977; 59 (6) 952.
• 9 Wennberg JE. Variations in medical practice and hospital costs. Conn Med 1985; 49 (7) 444-53.
• 10 Wennberg JE. Practice variations: why all the fuss?. Internist 1985; 26 (4) 6-8.
• 11 Wennberg JE. Population illness rates do not explain population hospitalization rates. A comment on Mark Blumberg's thesis that morbidity adjusters are needed to interpret small area variations. Med Care 1987; 25 (4) 354-9.
• 12 Wennberg JE, Gittelsohn A. Small area variations in health care delivery. Science 1973; 182: 1102-8.
• 13 McPherson K, Wennberg JE, Hovind OB, Clifford P. Small area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med 1982; 307 (21) 1310-4.
• 14 Stewart AL, Hays RD, Ware JE. The MOS short-form general health survey: reliability and validity in a patient population. Med Care 1988; 26: 724-32.