Saturday, October 10, 2009

from the St. Paul Pioneer Press this am: This is our clinic

Stillwater / Sharing of health decisions advocated
Clinic gets grant to expand program
By Jeremy Olson

Stillwater Medical Group has received a grant to expand its shared decision-making program, in which patients are trained to work with their doctors in selecting the best medical or surgical options.
The funding from the Boston-based Foundation for Informed Medical Decision Making allows the group's clinics to train male patients with enlarged prostates — a condition that isn't life-threatening and can be treated in multiple ways. The group has already used this approach on patients with breast and prostate cancers.
"They're typically conditions that have several different treatment options with the same long-term survival," said Joyce Kramer, an oncology nurse who provides the breast cancer training to patients. Selecting a treatment "becomes a matter of personal preference. What are your values? What's most important to you? What kind of side effects can you live with?"
The training typically involves a question-and-answer session with a nurse, and a DVD that reviews a patient's condition and treatment options. Kramer said the program has been meaningful for her breast cancer patients, who often see her right after being diagnosed but before they see a specialist to set a treatment plan.
"It's tough to go to the doctor and find out you have cancer," she said, "and then they start shooting all those decisions at you."
Stillwater Medical Group was one of the first small clinic groups to test shared decision-making,
which has been shown in research studies to improve patient satisfaction and confidence and reduce spending on unnecessary or questionable procedures. In the case of an enlarged prostate, for example, a man's treatment options vary from surgery to doing nothing.
In the case of breast cancer, women may have a tumor surgically removed from one breast or they may have both breasts removed entirely to eliminate any possible recurrence.
The potential cost savings of shared decision-making has caught the attention of lawmakers, who have proposed incentives in federal health reform bills so that more clinics will offer it. Critics question whether the approach is a veiled form of rationing and whether information provided to patients is complete and will remain updated.
In a news release issued Friday, the Boston foundation listed the Stillwater group as one of 10 grant recipients. Dr. Michael Barry, the foundation president, credited these recipients for "changing the face of health care by inviting patients to play an active role."
Kramer said the grant is a significant step forward for the Stillwater group. Previously, specialists ordered the training for cancer patients. Now the option will be available to the group's primary care doctors when they diagnose a patient with an enlarged prostate — which typically occurs in middle-aged and older men and can cause disruptions or pain during urination.
While insurance companies support shared decision-making, they typically don't pay for the training visits between patients and nurses. The financial justification for Kramer's training has instead come through the increasing number of patients who stay with the Stillwater group for their cancer care — instead of going to other cancer centers.
"The goal is ... to have an informed patient that can make a decision," she said. "Then they're invested because they were part of that decision."
Eventually, the Stillwater doctors plan to offer training in shared decision-making to patients with diabetes and low back pain.

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