Evidence about the effectiveness of different health care interventions is incomplete, contradictory, or associated with strong personal values or preferences.
There is a strong interest in studying how patients, professionals, and policymakers arrive at informed, preference-based decisions about health care.
The Dartmouth Institute for Health Policy and Clinical Practice's Health Decision Research (HDR) program focuses on several key aspects of patients' decision making.
Our fundamental research addresses questions about the basic processes underlying patients' decisions:
- What are the effects of different ways of presenting patients with information about screening, diagnostic testing, and treatment options?
- What are the best ways to measure patients' preferences about different options, risk/benefit tradeoffs, and outcomes of care?
- How does information comprehension and preference formation relate to subsequent decision behavior?
Our applied research involves working with consumers who wish to participate in making actual decisions about their own health care. This process is referred to as "shared decision making" (SDM). "Decision aids" (DAs) are practical tools that can help patients engage in shared decision making. We carry out this applied work in two arenas:
A. Preparation and Developmental Evaluation of New
Decision Aids for Shared Decision Making
We work with the Foundation for Informed Medical Decision Making to foster the creation of high-quality, multi-media, effective decision aids to support SDM. We do this by:
- Systematically researching, critically evaluating, and synthesizing the clinical evidence needed for decision aids;
- Interviewing physicians and patients about their experiences with various screening, testing, and treatment options;
- Incorporating this clinical evidence and interview material into DA prototypes; and
- Testing these prototypes with patients and practitioners.
B. Center for Shared Decision Making at Dartmouth-
Hitchcock Medical Center (DHMC)
The Center for Shared Decision Making at DHMC is an innovative program with two main purposes:
- Providing patients with individualized decision support by:
- Systematically assessing patients' decision making needs;
- Providing easy access to current high-quality decision aids; and
- Helping patients work with their doctors to arrive at informed, preference-based treatment choices.
- The Center is also creating electronic data-collecting systems that will allow us to evaluate the effectiveness of this decision support service.
- Providing health care professionals with educational opportunities to gain clinical skills in decision support.
Dr. Hilary Llewellyn-Thomas teaches ECS 120 (Studying Patients' Decisions), a course in the Dartmouth Institute for Health Policy and Clinical Practice Graduate Program.
"The course is extremely satisfying to teach, and very relevant for students who are intrigued by the scientific challenges of studying patients' decision making. Motivated students get deeply involved in this fascinating field, and they invariably create highly innovative approaches to complex research questions." (Llewellyn-Thomas, Epicenter, Fall 2000)
In addition, Hilary leads a Ph.D. seminar series that focuses on the theories and methods used to measure patients' attitudes toward different health states. She also supervises the work of graduate students studying patients' decision making.
Reports of our work appear in a wide range of journals in the decision sciences, clinical care, and health services research. Our work is also presented at various scientific meetings, particularly those of the Society for Medical Decision Making.