Correction Appended
Both Dartmouth-Hitchcock Medical Center and the new Dartmouth-Hitchcock Nashua campus have sought to expand their centers for collaborative decision-making to help patients make difficult medical choices, according to Susan Berg, interim program director for the Center for Shared Decision Making at DHMC.
"Sometimes there are two or more ways to go with how to treat things," DHMC-Nashua Medical Director Sanders Burstein said. "Even though evidence may point to one being better than the other in terms of outcome, someone's values may say, I don't want to do that.'"
DHMC Nashua's resource center, which opened as part of the new facility on Jan. 16, lends patients "decision aids" including booklets and DVDs, according to Burstein. The Center for Shared Decision Making on DHMC's main campus lends between 3,500 and 4,000 of these aids to patients this year, according to Berg.
These decision aids "pave the way" for patients to have conversations with a health coach or specialist, Burstein said. These aids, which were developed by the Foundation for Informed Medical Decision Making, now include condensed online resources that provide interactive material, according to Megan Bowen, the foundation's implementation manager. Bowen said that feedback indicated the DVD materials are more useful than online programs.
The nonprofit foundation produces the materials with Health Dialogue, a Boston-based commercial partner, Bowen said. The Center for Shared Decision Making at DHMC has access to these resources through a grant agreement with the foundation, exchanging research about decision quality for access to these materials, Berg said.
Each patient who uses an aid receives a questionnaire in order to determine if the patient understands the information presented, as well as if the patient's decision aligns with his or her values, according to Berg.
"It's a way to help patients realize their preferences matter," Berg said. "There is more than one reasonable way to proceed."
In addition to the decision aids, the Center also offers one-on-one decision counseling, Berg said.
Linda Mayo of Hartford, Vt., spoke with Berg last fall as part of this counseling. Mayo, who will donate a kidney to her brother, qualified for a stem cell research study and was unsure whether or not to participate, she said. Mayo and Berg discussed what could go wrong and how to weigh both personal and medical concerns, Mayo said.
"What I figured out after talking to her is that I was going to do everything it took to save my brother's life," Mayo said. "She wasn't afraid to ask me tough questions. One day, I saw a tear roll down her eye. I can't imagine what she must see and hear."
Mayo said she ultimately decided to participate in the study.
Dale Vidal, the director of the Center for Informed Choice at The Dartmouth Institute, adopted the Patient Support Corps program for use at DHMC, according to Nora-Ashley Harris, the project coordinator at the Center for Informed Choice.
Through the program, a patient meets with a medical, masters or undergraduate student before his or her appointment to generate a list of questions about their medical situation, the objective of the meeting, each surgeon's responsibilities and the evaluation of choices, Harris said.
This list is sent to a physician before the appointment, and the student attends the appointment, takes notes and records the doctor-patient conversation, Harris said. Patients are grateful for the additional help, she said.
"A lot of these appointments are high-stress situations," Harris said. "Even as an educated person, when I go to the doctor, sometimes I feel nervous. You don't want to seem silly by asking a question. You don't want to ask questions that could be perceived as wasting their time."
