Encounter Research - The Wiser Choices Program

The Wiser Choices Program is currently focused on the design, development and formal testing of patient-centered and evidence-based decision aids in clinical practice. These tools can help clinicians convey information to patients that will enable decisions that are both consistent with the best available evidence and with the values and preferences of the informed patient. Thus far, our work has shown that we can improve action (medication starts) and adherence (medication use) by involving patients with diabetes in the decision to use statins. Pilot work has shown that diabetes issue cards can help patients choose among alternative antihyperglycemic treatments, a heretofore “technical decision”. With greater patient involvement we hypothesize comes greater safety and efficacy in healthcare delivery.

Decision Aids

Statin Choice

The Statin Choice decision aid is designed to show patients their 10-year risk of heart attack based on an individualized assessment of patient-provided risk factors (blood pressure, gender, age, etc.) The patients are then shown their reduction of risk for heart attack when medicated with statins.

Publications

• Montori VM, Breslin M, Maleska M, Weymiller AJ. Creating a Conversation: Insights from the Development of a Decision Aid. PLoS Med. 2007 Aug 7; 4(8):e233. View in Pubmed.
• Helping Patients With Type 2 Diabetes Mellitus Make Treatment Decisions: Statin Choice Randomized Trial. Audrey J. Weymiller; Victor M. Montori; Lesley A. Jones; Amiram Gafni; Gordon H. Guyatt; Sandra C. Bryant; Teresa J. H. Christianson; Rebecca J. Mullan; Steven A. Smith. Arch Intern Med. 2007;167:1076-1082.

  Full Text of Main Report – Statin Choice Trial (courtesy Archives of Internal Medicine)

• Christianson TJ, Bryant SC, Weymiller AJ, Smith SA, Montori VM. A pen-and-paper coronary risk estimator for office use with patients with type 2 diabetes. Mayo Clin Proc. 2006 May;81(5):632-6. View in Pubmed

Downloads

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Diabetes Medication Choice

This decision aid provides evidence-based information about diabetes medication options and their characteristics to help patients take part in the clinical decision making process.

Related Resources

• Diabetes Medication Cards

Videos – Diabetes Medication cards in action

These are two video vignettes that describe one way of using the Diabetes Medication Cards.

• The Typical Case – this video shows how a fairly typical patient, insofar as values and preferences regarding medication, uses the Diabetes Medication Cards. View video
• A Surgical Nurse – this video shows how a patient who, because of her job context, holds particular preferences about medications uses the Diabetes Medication Cards to make a decision consistent with her preferences. View video