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Communicating About Evidence in Medicine Effectively
- 1. OFF THE KNOWN MAP Communicating About Evidence in Medicine Chuck Alston Senior Vice President/Director of Public Affairs MSL Washington © 2011 MSLGROUP SLIDE 1
- 2. The Public Context for Communicating About Evidence: How Bad Can It Get? Consider what’s been said about federal oversight of comparative effectiveness research • a national health care rationing board • an agenda that will destroy the doctor-patient relationship and set us on a course for government- administered health care • handing personal medical decisions over to the federal government • lays the groundwork for a permanent government rationing board prescribing care in place of doctors and patients © 2011 MSLGROUP SLIDE 2
- 3. Problem: They Don’t Hear What You (Think You) Are Saying Communicating about evidence is fraught with peril. © 2011 MSLGROUP SLIDE 3
- 4. Evidence One of Many Confusing Concepts What You Say What They Hear Medical home Nursing home, home health, end of life Medical decision support End-of-life decisions Guidelines or treatment guidelines Restrictive, rigid, limited, driven by cost Integrated health care delivery system Bureaucratic, industry language, meaning unclear Integrated care Bureaucratic, industry language, meaning unclear Multispecialty medical group Bureaucratic, industry language, meaning unclear, trying to do too much, low quality, limited choice of specialists to choose from Best practices Bureaucratic, meaning unclear, insincere, cookie-cutter care, not tailored to the individual Evidence-based medicine Impersonal, one size fits all Accountable Something will go wrong, minimal care, buzz word Source: Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal.13(1):8-16. 2009. © 2011 MSLGROUP SLIDE 4
- 5. Evidence, Schmevidence • Evidence, standards, measures – so what, who cares • Consumers’ reactions: • Threatens doctor-patient relationship • Inflexible, cookie-cutter medicine • May keep me from getting all the care they need (remember, more is better, most expensive is best) • Who decides, anyway? • Besides, my doctor said it, so it must be right Sources: Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs.29(7):1400-1406. July 2010. Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal.13(1):8–16. 2009. Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) © 2011 MSLGROUP SLIDE 5
- 6. The Way Medical Decisions Are Made “The dominant role of physicians in determining patient care has been a fact of medical care delivery for many decades. Therefore, many consumers may find it difficult to move into a more active and accountable role in which they are expected to understand and weigh multiple pieces of complex and potentially conflicting evidence.” Source:Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs.29(7):1400-1406. July 2010 © 2011 MSLGROUP SLIDE 6
- 7. What They Don’t Know Might … Most patients considering elective surgeries do not know how long it usually takes to recover, what the benefits of the surgery are, or how many people experience complications. Source: Zikmund-Fisher BJ, Russell LB and Pignone MP. Medical Decision Making. Boston: Foundation for Informed Medical Decision Making, 2010. © 2011 MSLGROUP SLIDE 7
- 8. SO WHAT, WHO CARES, WHAT’S IN IT FOR ME? Patient-centered Messaging © 2011 MSLGROUP SLIDE 8
- 9. The Problem with My Health Care Is… • Uneasy relationship with my doctor • Doctor is pressed, encounter feels rushed, questions go unanswered • Lack of clear, trustworthy information • Too many mistakes, too much miscommunication that can make things go wrong Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) © 2011 MSLGROUP SLIDE 9
- 10. Obstacles to Overcome with Patients • More $$$ = better care • More care = better care • Agency theory • For me, sky’s the limit © 2011 MSLGROUP SLIDE 10
- 11. “It’s All About Me” • Focus on the patient • Any message about delivery should focus on patient benefits © 2011 MSLGROUP SLIDE 11
- 12. Locate within Context of Better Care We are working to: • Improve your health care • Find better ways to care for you • Make sure you get the best care possible Source: Research conducted by MSL Washington for the Robert Wood Johnson Foundation. © 2011 MSLGROUP SLIDE 12
- 13. Where Do We Want to Go? Our goal for your care is: • Strong relationship with your doctor • Time with your doctor • Addressing all your concerns • Involving you in decisions about your care • Making sure you understand your follow-up care • After-hours help, alternatives to the emergency room © 2011 MSLGROUP SLIDE 13
- 14. How Do We Get There? How we are improving care: • Communication, coordination among doctors • All the preventive care you need • Make sure you get right medications and tests • Make appointments easily, fill out forms once, do not have to repeat yourself over and over • High-quality care, tailored just for you, based on best medical evidence and your doctor’s recommendation © 2011 MSLGROUP SLIDE 14
- 15. RELOCATING EVIDENCE ^Critical Element of Decision Making © 2011 MSLGROUP SLIDE 15
- 16. Proposed Messaging Approach Making the Best Decision for You • Locate the concepts of evidence and evidenced-based medicine under a larger umbrella concept– as one component of making the best decision for an individual patient • This makes evidence essential to, but by itself insufficient for, treatment decisions © 2011 MSLGROUP SLIDE 16
- 17. Approach Enjoys (Surprising?) Support • “ Science and research should be used to enhance and improve healthcare quality, not limit a patient’s choices or options. We should encourage doctors and healthcare professionals to share best practices and learn from each other’s experiences, but we need to recognize that every patient is different and every illness needs an individualized, personalized approach. Statistical analysis can help, but healthcare requires a human approach, timely decisions, and the right of patients to try an innovative approach if everything else has failed.” Frank I. Luntz Dr. Frank I. Luntz – The Language of Healthcare 2009 © 2011 MSLGROUP SLIDE 17
- 18. Evidence As Part of Shared Decision Making • Scientific information from research • The training and experience of health professionals • Patient’s goals, concerns, preferences © 2011 MSLGROUP SLIDE 18
- 19. Three Elements of Decisions • Each element is complementary and important to the right health decision for each individual patient • Patients and providers should communicate about all three © 2011 MSLGROUP SLIDE 19
- 20. Umbrella Message Concept “The right care starts with the right decision.” © 2011 MSLGROUP SLIDE 20
- 21. Core Message Concepts The right care starts with the right decision • The right decision results from doctors and patients working together to consider all of the relevant information. This includes the best medical information about what works and information about the patient’s goals and concerns. • Patients who partner with their doctors in care decisions have the best chance of reaching the decision that is right for them. • The right care depends on patients taking an active role in decision making by providing health information essential for the right decision and providers communicating the best available medical information about what works. • To achieve the right care, patients and clinicians need to be supported with the information, tools and environment for making the right decisions. © 2011 MSLGROUP SLIDE 21
- 22. Tested Description of Medical Evidence To find out what types of care work best, doctors and others do scientific studies of patient care. The results from this medical research are called “medical evidence.” Each patient is different, but medical research can show whether some types of health care tend to get better results than others for patients with certain conditions. When there is medical evidence from research that shows which care works best, then using that evidence is part of “good quality” care. Source: National Business Group on Health at http://communicationtoolkit.airprojects.org/communication-materials/basics-of-health-care- quality/ © 2011 MSLGROUP SLIDE 22
- 23. Final Takeaways When talking about evidence, guidelines, recommended care • Emphasize that national medical experts/organizations created the guidelines • They are based on scientific evidence • They not binding on anyone © 2011 MSLGROUP SLIDE 23
- 24. To Learn More • Bechtel C and Ness D. “If You Build It, Will They Come? Designing Truly Patient-Centered Health Care.” Health Affairs. 29(5): 914-920. May 2010. • Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence- based Health Care.” Health Affairs. 29(7): 1400-1406. July 2010. • Gerber A, et al. “A National Survey Reveals Public Skepticism About Research- Based Treatment Guidelines.” Health Affairs. 29(10): 1882-1884. October 2010. • Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal.13(1): 8–16. 2009. • “Talking About Health Care Payment Reform with U.S. Consumers." Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) • Zikmund-Fisher BJ, Russell LB and Pignone MP. “Medical Decision Making.” Boston: Foundation for Informed Medical Decision Making, 2010. © 2011 MSLGROUP SLIDE 24
Notas del editor
- This is a map of the world before Columbus sailed the ocean blue.Like Columbus, we are venturing off the known mapADVANCEAs I hope to show, that’s where much of health care communications is right now1/6 of economyRestructuring – not fast enough for payers, too fast forsmeproviders, bewildering to patients – more than models threatened, holds potential personal threatPeople don’t’ want to think about health care way payers are, providers are being forced to, and how some wish consumers would
- To paraphrase Geena Davis to Jeff Goldblum in The FlyBe careful, be very very careful
- Let me pause here a second and let you soak some of this inOn the left, some of those terms on the previous slideOn the right, what people think of when they hear those terms
- Few consumers understand terms “medical evidence” or recommended care, quality guidelines etcWhen asked about quality measures, consumers think:- Measures intrude on the doctor-patient relationship and don’t allow for personalized care- Leads to “one-size-fits-all” care, restrictive, inflexible, bureaucratic- Represent minimum standard of careProtect doctors from failing to provide better treatment than what is considered necessary.Evidence-based medicine – patients don’t think that care is based on anything besides what’s proven to work – kind of think it is all science or docs wouldn’t do it Especially concerned about tailoring being the 0.1 percentor having co-morbiditities
- Consumers don’t like to be called consumers in health carePassive – doctors knows bestMD – might diving
- Decisions Study from U of Mich -- FIMDM
- Problems people identified in research about delivery and payment reform
- Beliefs and realities we must overcome as communicators
- Offer “solutions” to problems they see – what does it mean for meExample of electronic records
- Make evidence “one” piece of the puzzle – not the be all and end all