Weitere ähnliche Inhalte Ähnlich wie Communicating About Evidence in Medicine Effectively Ähnlich wie Communicating About Evidence in Medicine Effectively (20) Mehr von CUE - Consumers United for Evidence-based Healthcare Mehr von CUE - Consumers United for Evidence-based Healthcare (20) Kürzlich hochgeladen (20) Communicating About Evidence in Medicine Effectively1. OFF THE KNOWN MAP
Communicating About Evidence in Medicine
Chuck Alston
Senior Vice President/Director of Public Affairs
MSL Washington
© 2011 MSLGROUP SLIDE 1
2. The Public Context for Communicating
About Evidence: How Bad Can It Get?
Consider what’s been said about federal oversight of
comparative effectiveness research
• a national health care rationing board
• an agenda that will destroy the doctor-patient
relationship and set us on a course for government-
administered health care
• handing personal medical decisions over to the federal
government
• lays the groundwork for a permanent government
rationing board prescribing care in place of doctors and
patients
© 2011 MSLGROUP SLIDE 2
3. Problem: They Don’t Hear What You (Think
You) Are Saying
Communicating about evidence is fraught with peril.
© 2011 MSLGROUP SLIDE 3
4. Evidence One of Many Confusing Concepts
What You Say What They Hear
Medical home Nursing home, home health, end of life
Medical decision support End-of-life decisions
Guidelines or treatment guidelines Restrictive, rigid, limited, driven by cost
Integrated health care delivery system Bureaucratic, industry language, meaning
unclear
Integrated care Bureaucratic, industry language, meaning
unclear
Multispecialty medical group Bureaucratic, industry language, meaning
unclear, trying to do too much, low quality,
limited choice of specialists to choose from
Best practices Bureaucratic, meaning unclear, insincere,
cookie-cutter care, not tailored to the individual
Evidence-based medicine Impersonal, one size fits all
Accountable Something will go wrong, minimal care, buzz
word
Source: Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente
Journal.13(1):8-16. 2009.
© 2011 MSLGROUP SLIDE 4
5. Evidence, Schmevidence
• Evidence, standards, measures – so what, who cares
• Consumers’ reactions:
• Threatens doctor-patient relationship
• Inflexible, cookie-cutter medicine
• May keep me from getting all the care they need (remember, more is
better, most expensive is best)
• Who decides, anyway?
• Besides, my doctor said it, so it must be right
Sources:
Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs.29(7):1400-1406. July 2010.
Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente
Journal.13(1):8–16. 2009.
Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors
given.)
© 2011 MSLGROUP SLIDE 5
6. The Way Medical Decisions Are Made
“The dominant role of
physicians in determining
patient care has been a fact of
medical care delivery for many
decades. Therefore, many
consumers may find it difficult
to move into a more active and
accountable role in which they
are expected to understand
and weigh multiple pieces of
complex and potentially
conflicting evidence.”
Source:Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs.29(7):1400-1406. July 2010
© 2011 MSLGROUP SLIDE 6
7. What They Don’t Know Might …
Most patients considering elective
surgeries do not know how long it
usually takes to recover, what the
benefits of the surgery are, or how
many people experience
complications.
Source: Zikmund-Fisher BJ, Russell LB and Pignone MP. Medical Decision Making. Boston: Foundation for Informed Medical Decision Making,
2010.
© 2011 MSLGROUP SLIDE 7
8. SO WHAT, WHO CARES, WHAT’S IN IT
FOR ME?
Patient-centered Messaging
© 2011 MSLGROUP SLIDE 8
9. The Problem with My Health Care Is…
• Uneasy relationship with
my doctor
• Doctor is pressed,
encounter feels rushed,
questions go unanswered
• Lack of clear, trustworthy
information
• Too many mistakes, too much miscommunication
that can make things go wrong
Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No
authors given.)
© 2011 MSLGROUP SLIDE 9
10. Obstacles to Overcome with Patients
• More $$$ = better care
• More care = better care
• Agency theory
• For me, sky’s the limit
© 2011 MSLGROUP SLIDE 10
11. “It’s All About Me”
• Focus on the patient
• Any message about delivery should focus on patient benefits
© 2011 MSLGROUP SLIDE 11
12. Locate within Context of Better Care
We are working to:
• Improve your health
care
• Find better ways to
care for you
• Make sure you get the
best care possible
Source: Research conducted by MSL Washington for the Robert Wood Johnson Foundation.
© 2011 MSLGROUP SLIDE 12
13. Where Do We Want to Go?
Our goal for your care
is:
• Strong relationship with
your doctor
• Time with your doctor
• Addressing all your concerns
• Involving you in decisions about your care
• Making sure you understand your follow-up care
• After-hours help, alternatives to the emergency room
© 2011 MSLGROUP SLIDE 13
14. How Do We Get There?
How we are improving
care:
• Communication,
coordination among
doctors
• All the preventive care
you need
• Make sure you get right
medications and tests
• Make appointments easily, fill out forms once, do not have to
repeat yourself over and over
• High-quality care, tailored just for you, based on best medical
evidence and your doctor’s recommendation
© 2011 MSLGROUP SLIDE 14
16. Proposed Messaging Approach
Making the Best Decision for You
• Locate the concepts of evidence and
evidenced-based medicine under a larger
umbrella concept– as one component of
making the best decision for an individual
patient
• This makes evidence essential to, but by
itself insufficient for, treatment decisions
© 2011 MSLGROUP SLIDE 16
17. Approach Enjoys (Surprising?) Support
• “ Science and research should be used to
enhance and improve healthcare quality, not
limit a patient’s choices or options. We should
encourage doctors and healthcare professionals
to share best practices and learn from each
other’s experiences, but we need to recognize
that every patient is different and every illness
needs an individualized, personalized approach.
Statistical analysis can help, but healthcare
requires a human approach, timely decisions,
and the right of patients to try an innovative
approach if everything else has failed.”
Frank I. Luntz
Dr. Frank I. Luntz – The Language of Healthcare 2009
© 2011 MSLGROUP SLIDE 17
18. Evidence As Part of Shared Decision Making
• Scientific information from research
• The training and experience of health
professionals
• Patient’s goals, concerns, preferences
© 2011 MSLGROUP SLIDE 18
19. Three Elements of Decisions
• Each element is complementary and important
to the right health decision for each individual
patient
• Patients and providers should communicate
about all three
© 2011 MSLGROUP SLIDE 19
21. Core Message Concepts
The right care starts with the right decision
• The right decision results from doctors and patients working together to
consider all of the relevant information. This includes the best medical
information about what works and information about the patient’s goals
and concerns.
• Patients who partner with their doctors in care decisions have the best
chance of reaching the decision that is right for them.
• The right care depends on patients taking an active role in decision making
by providing health information essential for the right decision and
providers communicating the best available medical information about what
works.
• To achieve the right care, patients and clinicians need to be supported with
the information, tools and environment for making the right decisions.
© 2011 MSLGROUP SLIDE 21
22. Tested Description of Medical Evidence
To find out what types of care
work best, doctors and others
do scientific studies of patient
care. The results from this
medical research are called
“medical evidence.”
Each patient is different, but
medical research can show
whether some types of health care tend to get better results
than others for patients with certain conditions. When there is
medical evidence from research that shows which care works
best, then using that evidence is part of “good quality” care.
Source: National Business Group on Health at http://communicationtoolkit.airprojects.org/communication-materials/basics-of-health-care-
quality/
© 2011 MSLGROUP SLIDE 22
23. Final Takeaways
When talking about evidence, guidelines,
recommended care
• Emphasize that national medical
experts/organizations created the guidelines
• They are based on scientific evidence
• They not binding on anyone
© 2011 MSLGROUP SLIDE 23
24. To Learn More
• Bechtel C and Ness D. “If You Build It, Will They Come? Designing Truly
Patient-Centered Health Care.” Health Affairs. 29(5): 914-920. May 2010.
• Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-
based Health Care.” Health Affairs. 29(7): 1400-1406. July 2010.
• Gerber A, et al. “A National Survey Reveals Public Skepticism About Research-
Based Treatment Guidelines.” Health Affairs. 29(10): 1882-1884. October
2010.
• Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer
Reaction to Our Current Health Care Dialect.” The Permanente
Journal.13(1): 8–16. 2009.
• “Talking About Health Care Payment Reform with U.S. Consumers." Princeton,
N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
• Zikmund-Fisher BJ, Russell LB and Pignone MP. “Medical Decision Making.”
Boston: Foundation for Informed Medical Decision Making, 2010.
© 2011 MSLGROUP SLIDE 24
Hinweis der Redaktion This is a map of the world before Columbus sailed the ocean blue.Like Columbus, we are venturing off the known mapADVANCEAs I hope to show, that’s where much of health care communications is right now1/6 of economyRestructuring – not fast enough for payers, too fast forsmeproviders, bewildering to patients – more than models threatened, holds potential personal threatPeople don’t’ want to think about health care way payers are, providers are being forced to, and how some wish consumers would To paraphrase Geena Davis to Jeff Goldblum in The FlyBe careful, be very very careful Let me pause here a second and let you soak some of this inOn the left, some of those terms on the previous slideOn the right, what people think of when they hear those terms Few consumers understand terms “medical evidence” or recommended care, quality guidelines etcWhen asked about quality measures, consumers think:- Measures intrude on the doctor-patient relationship and don’t allow for personalized care- Leads to “one-size-fits-all” care, restrictive, inflexible, bureaucratic- Represent minimum standard of careProtect doctors from failing to provide better treatment than what is considered necessary.Evidence-based medicine – patients don’t think that care is based on anything besides what’s proven to work – kind of think it is all science or docs wouldn’t do it Especially concerned about tailoring being the 0.1 percentor having co-morbiditities Consumers don’t like to be called consumers in health carePassive – doctors knows bestMD – might diving Decisions Study from U of Mich -- FIMDM Problems people identified in research about delivery and payment reform Beliefs and realities we must overcome as communicators Offer “solutions” to problems they see – what does it mean for meExample of electronic records Make evidence “one” piece of the puzzle – not the be all and end all