The study was conceived by John Wennberg, a Dartmouth Medical School professor and founder of the Atlas, and Shannon Brownlee, a Dartmouth Institute for Health Policy and Clinical Practice instructor and acting director of the New America Health Policy Program.
The researchers aim to help patients, families and physicians better understand the importance of variations in care, and that patients' preferences are not always considered by doctors, according to the report.
When it comes time to determine the best treatment option, "the patient's values really matter," DMS professor and co-author of the report Julie Bynum said. Patients' decisions depend on the way in which they weigh various risks, she said.
Brownlee cited the example of women with early-stage breast cancer who must choose which procedure to undergo as a classic situation in which doctors should consider patients' preferences. Patients can either receive a mastectomy, which results in the removal of breast tissue, or a lumpectomy, which relies on radiation and preserves much of the patient's tissue, according to Brownlee.
"The fact is that they're equivalent in terms of how much they reduce the woman's risk of dying of her disease," she said. "But they're very different in terms of how they affect her."
Brownlee said she hopes the report will help bring about changes in patient decision-making.
"Physicians are starting to get interested in this," she said. "They're starting to really grapple with the fact that their patients need to have better information and they need to have information that they can understand."
Doctors are currently "not that great at communicating" the choices available to patients because they are not trained in medical school to help patients work through their values, Brownlee said. Physicians are also constrained by time and feel overwhelmed by other requirements, she said.
The Affordable Care Act, signed into law in March 2010, contains provisions designed to promote shared decision-making between doctors and patients, according to Brownlee. The law, however, does not have the financial backing needed to make a true impact, she said.
"It's all great in theory for the government to promote this, but until the money is there, it's still kind of in the talk stage," Brownlee said.
State legislatures should also promote pilot projects and change malpractice laws to help protect physicians from lawsuits and encourage better shared decision-making, Brownlee said. Allowing patients to participate in their decision-making will ultimately lead to better health outcomes, according to Bynum.
"Really having patients engaged and understanding their choices is helpful," she said. "Patients [should be] informed of the risks and benefits."
Variations in reimbursement rates between procedures can also complicate medical decision-making, according to Bynum.
"Sometimes, financial incentives can make some of these choices more challenging for doctors to be unbiased about," Bynum said.
Although the study's topic has been researched previously, Brownlee and fellow researchers were determined to present the information to patients in a more accessible way, she said.
Patients are often unaware that treatment decisions are "theirs to make," Brownlee said in an interview with The Dartmouth.
The paper strives to convey to patients that they should communicate with doctors to determine which procedures to undergo, according to Brownlee. TDI researcher Michael Barry, DMS professor David Goodman and primary investigator for the Atlas Elliott Fisher also co-authored the report.
