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Winter 2004 Edition
January 26, 2004
In our first Health e-Bytes commentary, we discussed the potential
value of patient-provider portals as a viable eHealth platform
to increase reach, access, and enhance communication. For this
next installment, our focus is on a related topic, namely, informed
decision-making (IDM) and the potential role for eHealth to enable
and support the concept of IDM. The recent series of articles
in the American Journal of Preventive Medicine [Briss, P. et al.,
Promoting Informed Decisions about Cancer Screening in Communities
and Healthcare Systems, Am J Prev Med 2004; 26(1):67-80, and Kaplan,
R. Shared Medical Decision Making: A New Tool for Preventive Medicine,
Am J Prev Med 2004; 26(1)81-83] addresses this timely and important
topic and the related concept of shared decision-making (SDM).
The United States Preventive Services Task Force (USPSTF) defines
IDM as “an individual’s overall process of gathering
relevant information from both his or her clinician and from other
clinical and non-clinical sources, with or without independent
clarification of values.” SDM goes further to include the
involvement of the clinician with the patient in the decision
making process. Although the USPSTF concluded, with respect to
interventions designed to enable IDM for cancer screening, that
the current evidence is insufficient to determine the effectiveness
of IDM interventions for patients or providers, it acknowledges
that there is consistent evidence that these interventions can
improve knowledge, beliefs and risk perceptions. The authors of
this series call for more systematic research on IDM and SDM,
particularly the role of cognitive factors and approaches to deployment
in clinical settings.
So how is eHealth relevant to this discussion? Well, the fact
that 140 million Americans and growing are online in the U.S.
today, and an estimated 80% of those are seeking health information
for themselves or family members, speaks to the enormous potential
for eHealth to enable IDM and SDM. Indeed, as one of my physician
colleagues commented recently, “Patients are presenting
and discussing the information they glean from the Internet with
their doctors every day throughout the U.S. and engaging in a
form of SDM.” What isn’t clear at this point, and
certainly warrants further research as recommended by Kaplan,
is precisely what takes place in the context of these patient-provider
communications. Further, there is little systematic evidence about
the “shared” aspects of these discussions and the
impacts, both positive and negative they may have on patient behavior
and health outcomes. Finally, the task of integrating SDM within
the context of routine clinical care remains formidable.
Several of our current grantees are investigating the topic of
patient/provider communication and its impact on chronic disease
management and health behavior change. We encourage the research
community at large to explore ways in which eHealth can serve
as a model for evaluating IDM and SDM interventions.
2004 promises to be an exciting year for eHealth!
David K. Ahern, Ph.D.
National Program Director
The views expressed in this article are those of the author
and do not imply endorsement by The Robert Wood Johnson Foundation.
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