Cost information greatly enhances the value of shared decision making

Cost information, when paired with information about clinical treatment options, greatly enhances the value of shared decision making, reported a FAIR Health brief released today.

This was among the lessons learned from a FAIR Health initiative presenting patient decision aids for shared decision making in palliative care scenarios, as described in the brief Cost Information Enhances Shared Decision Making: Lessons from FAIR Health's Shared Decision-Making Initiative.

Shared decision making means the discussion between patients/caregivers and healthcare providers regarding various treatment options, guided by evidence-based strategies and patient decision aids.

Shared decision making shows promise for reducing unnecessary healthcare spending and costs, and for improving decision making without adverse effects on clinical outcomes.

But in the past, the utility of shared decision-making tools, or decision aids, has been limited by the absence of cost data to complement the clinical information.

As part of a pilot generously funded by The New York Community Trust, FAIR Health launched a new shared decision-making feature with cost information in March 2020. The feature combines cost data from FAIR Health with decision aids for three palliative care scenarios:

• Kidney dialysis for patients with kidney failure (whether to continue or stop);
• Nutrition options when swallowing is difficult; and
• Breathing assistance (whether to continue or stop).

Following the successful implementation of this initiative, FAIR Health compiled its findings from the program in a brief so that a range of stakeholders--clinicians, payors, policy makers and the like--can use these learnings in future shared decision-making initiatives. Among the lessons learned were:

• Conversations surrounding cost in palliative care are part of decision making;
• Shared decision-making tools are useful and valuable for providers and patients alike;
• There is an appetite for additional shared decision-making tools for other medical conditions;
• Provider acceptance of these tools is a critical pathway for promoting shared decision making;
• There is a need to improve awareness of shared decision making and patient decision aids among providers; and
• Palliative care conversations require special sensitivity.

As noted, the program findings confirm the utility of cost information in shared decision making. Notably, conversations about clinical treatment options and costs present an opportunity to empower healthcare consumers and patients to make critical healthcare decisions with their clinicians that not only affect their health but their finances.

FAIR Health collaborated with organizations and professionals, such as Dr. Glyn Elwyn, BA, MD, MSc, PhD, professor at the Geisel School of Medicine at Dartmouth College, and Dr. Diane Meier, Director of the Center to Advance Palliative Care, to create, evaluate and promote awareness of this resource.

The findings from this initiative are being used to inform FAIR Health's currently active project, generously funded by the Fan Fox and Leslie R. Samuels Foundation, to create a companion educational site for healthcare providers.

This new initiative contemplates the development and dissemination of a provider-facing, online educational portal that will promote the use of the shared decision-making tools to New York City-based providers serving older adults with serious illnesses. FAIR Health will launch the new portal in March 2021.

Based on the insights FAIR Health collected, we observed that providers and consumers alike deemed the shared decision-making tools useful and valuable to their conversations in palliative care scenarios. We hope to expand our efforts in shared decision making to other preference-sensitive conditions through future collaborations."

Robin Gelburd, President, FAIR Health

Diane E. Meier, MD, Director of the Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, stated: "Having witnessed the need for clear and accurate information when making critical health decisions during chronic and serious illness, I am heartened by FAIR Health's effort to promote shared decision making for patients and caregivers when they most need clarity and guidance."