ONA: Which types of tools are more likely to effectively encourage men to participate in their health care decision making: Web-based (independent searches or clinician-directed use), in-person meetings (one-on-one or group), or print materials?

GOLDBACH: Our research has shown that men and women are equally interested in participating in their health care decisions. Although people can access so much health information in today’s world, high quality information that is not tainted by commercial interests can be hard to come by. At Health Dialog, we found that the most useful tools are those endorsed by physician experts, provide unbiased and evidence-based information, are easy to understand, and feature examples of different health care decisions made by other people based on their individual situations and preferences. Barriers to access for decision-making tools must be low. The tools should be available online as well as in hard-copy booklet form, and must be easy to understand.


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Health Dialog programs are often asked to identify patients in a population who are facing medical/surgical decisions so that we canoffer the support they need. For example, patients may not know about treatment options available to them or may not understand why some options are contraindicated for them. Health coaching can help with that.

An opportunity to engage with a health care professional such as a coach who can guide the patient through an episode of care should be part of the tools offered to patients. People do not always know they are facing a health care decision, and providers do not always have the same goals as their patients.

ONA: Explain the basic concepts of shared decision making.

GOLDBACH: We discussed how patients often face important decisions because more than one evidence-based treatment option exists and how SDM programs can be useful in these situations.

SDM programs are designed to ensure that patients are aware of the available options. For example, patients who have a fear of colonoscopies may not realize that other noninvasive screenings (eg, fecal occult blood test [FOBT] smear) may be an option for them.

Treatment goals can also impact health care decisions as well. In a survey of women and health care providers, the participants were asked to list their goals and concerns when making breast cancer care decisions. The providers’ top three concerns were significantly different from those of their patients (Figure 1).

Programs can be population based (ie, for health insurance companies). In this case, these programs rely on analytics to identify patients in need and outreach programs designed to engage these patients. SDM programs can also be practice based (ie, offered by the health care provider) or employer based (ie, part of a comprehensive wellness program that promotes appropriate screenings and preventive health behaviors).