Medical Decision Making Forum

Main Category: Public Health
Also Included In: Primary Care / General Practice
Article Date: 27 Jan 2008 - 12:00 PDT

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The Foundation for Informed Medical Decision Making (FIMDM) hosted more than 100 health care leaders at Boston's Omni Parker House on January 24-25 to discuss 14 research projects that reveal new insights about medical variations and standards of care.

Research findings included:

* International variations in the rate of surgery, including cardiac, spinal, hysterectomy and appendectomy procedures, for example, the U.S. performs spinal fusions at a rate almost five fold greater than the next leading country - and women have a higher rate of spinal fusion comparatively.

* Variations in U.S. cardiac interventions, highlighting the latest trend information from the Dartmouth Atlas Project, which documents geographic differences in the cost and quality of U.S. health care.

* Variations in U.S. breast cancer care showing differences in treatment of breast cancer and how an informed patient's preference can dramatically influence the clinical care, as demonstrated with lumpectomies vs. mastectomies (lumpectomies chosen 60 percent of the time).

* Rethinking the current legal standard of informed consent for medical procedures, as well as results from six focus groups testing the effect of using decision aids in a hypothetical malpractice case involving an allegation of failure by a primary care physician to order a PSA test for the plaintiff, a patient who later developed incurable prostate cancer.

* Report on Washington State's shared decision making legislation, which represents the first acknowledgment by a state legislature that there is growing evidence that medical outcomes can be improved by patient-practitioner communication enhanced by high-quality decision aids. The legislation formally recognized shared decision making in the state's laws on informed consent and encouraged collaborative efforts to develop, certify, use and evaluate decision aids.

* Hidden costs and economic impact of breast cancer treatment on patients - while direct medical costs associated with breast cancer and its treatment in the U.S. in 2006 were estimated to be more than $11 billion (extrapolated from the National Cancer Institute generated analyses), this research estimates the cost of non-medical expenses to the individual breast cancer patient and how this cost might influence treatment decisions.

Additionally, prominent authors made the case that "more care is not better care" including Nortin Hadler, from the University of North Carolina at Chapel Hill, author of The Last Well Person; Shannon Brownlee of the New America Foundation and author of Overtreated; and Richard Deyo from Oregon Health and Science University, author of Hope or Hype.

Representatives from non-profit organizations including National Committee for Quality Assurance, American Academy of Family Physicians, National Partnership for Women & Families, Consumers Union, the Permanente Federation and Robert Wood Johnson Foundation joined researchers and health care practitioners at the Medical Decision Making Forum.

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Article adapted by Medical News Today from original press release.
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About the Foundation for Informed Medical Decision Making (FIMDM)

FIMDM is a non-profit organization dedicated to assuring that people understand their choices and have the information they need to make sound decisions affecting their health and well being. The Foundation organizes and frames medical evidence in an unbiased manner to help people evaluate their options, particularly in instances where differences in individual preferences and perspectives are likely to affect personal choice. For more information, visit http://www.fimdm.org/.

Source: Vicky Jaffe
Manning Selvage & Lee