Center for Informed Choice
  The Dartmouth Institute
  Center for Informed Choice
  Summer Institutes
  2009 SIIPC
  Background and Objectives
  2008 SIIPC
  2007 SIIPC
  Center for Informed Choice
The Dartmouth Institute for Health Policy & Clinical Practice
35 Centerra Parkway, Suite 300
Lebanon, NH 03766 USA
Phone: (603) 653-0867
Fax: (603) 653-0896
Background and Objectives  


  1. Identify promising theories and methods for providing patients with decision support in multiple-option / multiple-objective decision situations.
  2. Develop collaborative links among scientists who are prepared to investigate key theoretical and methodological research questions about patients’ decision support in multiple-option / multiple-objective decision situations.
  3. Anticipate emerging trends in the study of patients’ decision support in multiple-option / multiple-objective decision situations.

Why This Particular Theme at This Particular Time?

We Have Made Progress with PtDAs:

  • The efficacy of good-quality PtDAs as tools to help provide patients with decision support has been established.
  • The infrastructure for building/maintaining libraries of effective PtDAs is growing and improving.
  • International consensus standards for designing/testing PtDAs have been developed.

We Have Made Progress with DS Models & Measures:

  • Several models for implementing decision support services have been developed.
  • We have measures to assess the quality of the decision support process as well as the quality of the choices that patients actually make.

We Have Made Progress with Teaching DS/PtDAs as a Clinical Skill:

  • Several models for teaching DS/PtDAs as a clinical skill have been developed and implemented

However: Two challenges to our current approaches for designing DS/PtDA are rapidly emerging. If unaddressed, these may handicap our efforts to incorporate DS/PtDAs into the stream of regular clinical care

  • First, as more new “high-tech” interventions, devices, and materials appear, we anticipate the need to design novel PtDAs that can help patients comprehend this complex information and sort through diverse options’ conflicting pros and cons. For example, we anticipate that patients with osteoarthritis who are considering knee replacement surgery will not only be involved in opting for or against surgery, but also, if they opt for surgery, in choosing among different surgical approaches and prosthetic materials. However, to date, PtDAs have tended to be designed for deliberating about single-event “cross-roads” in care, rather than for considering and choosing among nested, contingent options.
  • Second, as the proportion of older patients with multiple chronic conditions increases, with some aspects of care clearly indicated by high-quality clinical evidence and other aspects resting squarely in the preference-sensitive arena, we anticipate the need for multiple-conditions / multiple-objectives decision support systems. These novel systems would need to be able a) to integrate patient education materials (designed to help patients to understand their practitioners’ clearly-indicated recommendations for care) with DS/PtDAs (designed to help patients make values-based informed choices among relevant preference-sensitive care options); b) to clarify, communicate, and establish patients’ priorities for recommended/optional care; and c) subsequently, to help with the coordinated implementation of these individualized health care management plans.


  • This is an opportune time to build collaborative links among experts in patients’ decision support who are prepared to develop, test, and implement effective approaches to providing decision support for patients who are facing multiple-option / multiple-objective decisions.

This is the background motivation for the 2009 SIIPC


The Dartmouth Institute