Choosing Wisely Communica1on Skills Modules

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1 Choosing Wisely Communica1on Skills Modules Pamela Duke, MD Assistant Professor of Medicine, Drexel University College of Medicine Dennis Novack, MD Associate Dean of Medical Educa<on, Drexel University College of Medicine

2 Acknowledgements ABIM Founda<on Drexel University College of Medicine Consumer Reports American Academy of Health Care Communica<on Advisory Board (Drs. Beth Lown, Wendy Levinson and John Santa) Co- Collaborators: Christof Daetwyler, MD

3 Goals of the Webinar What are the Choosing Wisely Communica<on Modules? What are the core communica<on strategies that engender pa<ent trust and sa<sfac<on? How can providers learn Choosing Wisely informa<on easily and communicate it to their pa<ents using the modules? How can you put these modules into your grant in order to advance Choosing Wisely?

4 What do the Choosing Wisely Communica1on Modules offer? Easy to use on- line educa<onal resource Quick resource on key communica<on skills for nego<a<ng with pa<ents Interac<ve with video and instant polling Provides one resource linking medical knowledge with communica<on skills Holds both specialty society informa<on/consumer Reports for fast use by medical offices

5 Background Doc.com is a comprehensive online resource on healthcare communica<on. Launched in 2007 now with 42 modules: >14,000 subscribers and over 30 medical schools and many residency programs na<onally and worldwide. Doc.com evidence- based text, over 400 videos/annotated videos and a learning management system that allow students and faculty members to interact over a variety of communica<on skills topics.

6 hfp://webcampus.drexelmed.edu/doccom/user/

7 Choosing Wisely Communica1on Modules Specialty socie1es iden1fied tests or procedures commonly used in their field, whose necessity should be ques1oned and discussed. 1. American College of Physicians 2. American Society of Nephrology 3. American College of Cardiology 4. American College of Nuclear Cardiology 5. American College of Radiology 6. American Academy of Family Physicians 7. American Academy of Allergy, Asthma, & Immunology 8. American Gastroenterology Associa1on 9. American Academy of Pediatrics

8

9 INSTANT POLLING: PRE AND POST

10 Choosing Wisely Overview An ini1a1ve of the ABIM Founda1on to help physicians and pa1ents engage in conversa1ons to reduce overuse of tests and procedures

11 KEY COMMUNICATION SKILLS 1.Provide clear recommenda1ons. 2.Elicit pa1ents beliefs/ask ques1ons. 3.Provide empathy, partnership and legi1ma1on. 4.Confirm agreement/overcome barriers. Evidence Based Video Examples

12 Provide Clear Recommenda1ons Pa<ents want their physician to provide informa<on. Studies have shown that clinical outcomes such as blood pressure improve when physicians provide clear informa<on. Powell H, Gibson PG. Op<ons for self- management educa<on for adults with asthma. The Cochrane Database of Systema<c Reviews. 2003;1:1-44

13

14 Elicit Pa1ents Beliefs/Ques1ons Many pa<ents won t express these concerns unless asked for fear of embarrassment. But if these hidden concerns remain unsolicited and unaddressed, the concerns may become the cause of persistent requests for medica<ons or further tes<ng. Del Piccolo L. Sal<ni A, Zimmerman C & Dunn G. Difference in verbal behaviors of pa<ents with and without emo<onal distress during primary care consulta<on.2000;psycho Med:30: White J, Levison W Toter D Oh, by the way the closing moments of the medical visit 1995, JGIM, 9,

15 Provide Empathy, Partnership & Legi1ma1on Studies have demonstrated that empathic comments do not take much <me or prolong encounters, and have a number of posi<ve outcomes for pa<ents including beoer blood pressure and glucose control. Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR. Can 40 seconds of compassion reduce pa<ent anxiety? J Clin Oncol. 1999;17:371-9.

16 Confirm Agreement & Overcome Barriers Check for pa<ent understanding and agreement/ explora<on of any barriers to adherence. Arranging follow- up plans will reassure the pa<ent of your con<nued care. Finally acknowledging your support during the closure of the interview with concern solidifies a sense of partnership with your pa<ent and can improve health outcomes. Stewart MA. Effec<ve Physician- Pa<ent Communica<on and Health Outcomes: A Review. Can Med Assoc J. 1995;152:

17 Skills Summary hop://webcampus.drexelmed.edu/interac<ve/ choosingwisely/modules/m_02/ default_frameset.htm

18 Specialty Specific Top 5 Choices Text Video References Links to specialty sites Links to calculators if applicable (cardiac risk factors, osteoporosis)

19

20 Don t obtain imaging studies in pa1ents with non- specific low back pain. In pa1ents with back pain that cannot be afributed to a specific disease or spinal abnormality following a history and physical examina1on (e.g., non- specific low back pain), imaging with plain radiography, computed tomography (CT) scan, or magne1c resonance imaging (MRI) does not improve pa1ent outcomes. High quality evidence that imaging pa3ents with acute low back pain of 6 weeks dura3on with no red flags results in no clinical benefits and is associated with harms 1,2 1 Chou R, Qaseem A, Owens DK et al. Diagnos<c imaging for low back pain: advice for high value health care from an American pain society/american college of physicians clinical prac<ce guideline. Ann Intern Med 2011;154: Shubha SV, Deyo RA, Berger ZD. Applica<on of Less is More to Low Back Pain. Arch Intern Med,. 2012;172(13):

21 Evidence of Harm Pa<ent Labeling Imaging reveals anatomic abnormali<es in asymptoma<c people 1 Diminished sense of wellbeing 2 Increased rate of surgery 8 fold increase risk for surgery 3 Radia<on 1 Jensen MC, Brant- Zawadski MN, Obuchowski N et al. Magne<c resonance imaging of the lumbar spine in people without back pain. NEJM. 1994;33 (2); Modic MT, Obuchowski NA, Ross JS et al. Acute low back pain and radiculopathy :MR imaging findings and their prognos<c role and effect on outcome. Radiology. 2005;237 (2): Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28 (6);

22 Video Example hop://webcampus.drexelmed.edu/skills/ annotatedvideos/annotatevideo.aspx?a=325

23 Easy to print out Link provided Give at end/during visit Used in video Pa1ent Handout

24 Tool Kit for Choosing Wisely ACP Communica1on Module Video example Links References Copy of Choosing Wisely document in pdf Evidence based guidelines Links to Consumer Report free pdf handouts

25 How Can You Use these Videos Discussion Prac<ce sesng Pa<ent safety State medical socie<es CME Part of chart review Trainees Physicians, other providers and staff

26 Appreciate any feedback.

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