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You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of Health","lastName":null,"slug":"state-of-health","email":"stateofhealth@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"State of Health | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"},"eveharris":{"type":"authors","id":"8372","meta":{"index":"authors_1591205172","id":"8372","found":true},"name":"Eve Harris","firstName":"Eve","lastName":"Harris","slug":"eveharris","email":"harriseve@hotmail.com","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/82d1c9195656a3a8b3c2a2a2e50d8242?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"stateofhealth","roles":["contributor"]}],"headData":{"title":"Eve Harris | 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FM","link":"/"}},"stateofhealth_48802":{"type":"posts","id":"stateofhealth_48802","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"48802","score":null,"sort":[1437364939000]},"guestAuthors":[],"slug":"engaging-vaccine-hesitant-parents-on-values-shared-decision-making","title":"One Way to Increase Vaccination Rates: Calm Discussion?","publishDate":1437364939,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The question of declining children's vaccination rates -- and how to improve them -- exploded into the public consciousness early this year when a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/07/nine-measles-cases-tied-to-disneyland-parks/\" target=\"_blank\">measles outbreak\u003c/a>, linked to Disneyland, spread across California and to other states.\u003c/p>\n\u003cp>Since then, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a>, a bill to abolish the state's vaccine \"personal belief exemption,\" moved through the legislature amid heated and vocal opposition. It was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">signed by the governor\u003c/a> last month. Under the law, all school children must be vaccinated against 10 different diseases. Only those who cannot be vaccinated for medical reasons are exempt.\u003c/p>\n\u003cp>A Perspective published in the journal \u003ca href=\"http://pediatrics.aappublications.org\" target=\"_blank\">Pediatrics\u003c/a> offers a thoughtful breather on the rancorous debate we've seen in California. In the essay, \u003ca href=\"http://holly.witteman.ca/index.php/about/\" target=\"_blank\">Holly Witteman\u003c/a>, an assistant professor of medicine at Laval University in Quebec, writes in favor of applying a \"shared decision making\" approach with vaccine hesitant parents. This means engaging them with a combination of information and helping people clarify their values.\u003c/p>\n\u003cp>\"What I like about approaches like shared decision making,\" Witteman told me in an email, \"is that they center the conversation around what matters to patients.\"\u003c/p>\n\u003cp>\"We should at least be talking about these kinds of approaches when we talk about concerns about immunization rates, rather than throwing up our hands as though there is nothing that can be done to help parents overcome vaccine hesitancy.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Witteman is not a physician and when friends ask about vaccines, she advises them to talk to their doctor, but she's also an expert in medical decision-making. In the essay she describes conversations with friends and family members where she explains why she has chosen to vaccinate her own children. She talks about the facts around vaccines -- both risks and benefits -- but she also goes beyond facts to her own values:\u003c/p>\n\u003cblockquote>\u003cp>I explain how I am willing to accept the very small risks of vaccines because I could never live with myself if my children were injured or killed by a vaccine-preventable disease or if they passed along a virus to someone more vulnerable and I had done nothing to prevent such events.\u003c/p>\u003c/blockquote>\n\u003cp>She points to early research trials which suggest that providing shared decision-making tools helps to\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16287399\" target=\"_blank\"> increase vaccination rates\u003c/a>. She cites an anecdote from her own experience -- a friend who pointed to the \"respectful factual calm\" reassurance from Witteman that contributed to the family starting vaccines for their child.\u003c/p>\n\u003cp>\"It's such a crazy polarized topic everywhere,\" the friend commented to Witteman on Facebook (and Witteman shares in the Perspective with permission), \"that it's really hard to have a conversation about it without feeling attacked. Thank you.\"\u003c/p>\n\u003cp>This is what I have seen as I have covered the debate around SB 277. Those who fear vaccines were called stupid, anti-scientific or selfish -- which is unlikely to help improve vaccination rates, Witteman suggests. \"It may feel good to rant and rave, but people rarely change their minds because someone called them stupid and wrong.\"\u003c/p>\n\u003cp>Now it remains to be seen if requiring vaccines to attend school for all but those with a medical exemption will improve vaccination rates. Witteman says she's not opposed to the law, but in an email said she \"wonder(s) if it might backfire by increasing polarization, entrenching views, and driving parents who are vaccine hesitant further toward vaccine refusal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now a former Assemblyman has filed paperwork with the Office of the Attorney General for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/california-vaccine-debate-not-quite-over-tim-donnelly-files-referendum-to-overturn-new-law/\" target=\"_blank\">a referendum to overturn SB 277\u003c/a>. Backers of the law's repeal have until late September to gather 365,880 signatures to qualify for the Nov. 2016 ballot. If they are successful, the law will be put on hold until after the election.\u003c/p>\n\n","blocks":[],"excerpt":"Calm discussion of facts and exploration of parents' values helps move some toward vaccinating their children, author writes.","status":"publish","parent":0,"modified":1437414646,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":616},"headData":{"title":"One Way to Increase Vaccination Rates: Calm Discussion? | KQED","description":"Calm discussion of facts and exploration of parents' values helps move some toward vaccinating their children, author writes.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"One Way to Increase Vaccination Rates: Calm Discussion?","datePublished":"2015-07-20T04:02:19.000Z","dateModified":"2015-07-20T17:50:46.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"48802 http://ww2.kqed.org/stateofhealth/?p=48802","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/19/engaging-vaccine-hesitant-parents-on-values-shared-decision-making/","disqusTitle":"One Way to Increase Vaccination Rates: Calm Discussion?","path":"/stateofhealth/48802/engaging-vaccine-hesitant-parents-on-values-shared-decision-making","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The question of declining children's vaccination rates -- and how to improve them -- exploded into the public consciousness early this year when a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/07/nine-measles-cases-tied-to-disneyland-parks/\" target=\"_blank\">measles outbreak\u003c/a>, linked to Disneyland, spread across California and to other states.\u003c/p>\n\u003cp>Since then, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a>, a bill to abolish the state's vaccine \"personal belief exemption,\" moved through the legislature amid heated and vocal opposition. It was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">signed by the governor\u003c/a> last month. Under the law, all school children must be vaccinated against 10 different diseases. Only those who cannot be vaccinated for medical reasons are exempt.\u003c/p>\n\u003cp>A Perspective published in the journal \u003ca href=\"http://pediatrics.aappublications.org\" target=\"_blank\">Pediatrics\u003c/a> offers a thoughtful breather on the rancorous debate we've seen in California. In the essay, \u003ca href=\"http://holly.witteman.ca/index.php/about/\" target=\"_blank\">Holly Witteman\u003c/a>, an assistant professor of medicine at Laval University in Quebec, writes in favor of applying a \"shared decision making\" approach with vaccine hesitant parents. This means engaging them with a combination of information and helping people clarify their values.\u003c/p>\n\u003cp>\"What I like about approaches like shared decision making,\" Witteman told me in an email, \"is that they center the conversation around what matters to patients.\"\u003c/p>\n\u003cp>\"We should at least be talking about these kinds of approaches when we talk about concerns about immunization rates, rather than throwing up our hands as though there is nothing that can be done to help parents overcome vaccine hesitancy.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Witteman is not a physician and when friends ask about vaccines, she advises them to talk to their doctor, but she's also an expert in medical decision-making. In the essay she describes conversations with friends and family members where she explains why she has chosen to vaccinate her own children. She talks about the facts around vaccines -- both risks and benefits -- but she also goes beyond facts to her own values:\u003c/p>\n\u003cblockquote>\u003cp>I explain how I am willing to accept the very small risks of vaccines because I could never live with myself if my children were injured or killed by a vaccine-preventable disease or if they passed along a virus to someone more vulnerable and I had done nothing to prevent such events.\u003c/p>\u003c/blockquote>\n\u003cp>She points to early research trials which suggest that providing shared decision-making tools helps to\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16287399\" target=\"_blank\"> increase vaccination rates\u003c/a>. She cites an anecdote from her own experience -- a friend who pointed to the \"respectful factual calm\" reassurance from Witteman that contributed to the family starting vaccines for their child.\u003c/p>\n\u003cp>\"It's such a crazy polarized topic everywhere,\" the friend commented to Witteman on Facebook (and Witteman shares in the Perspective with permission), \"that it's really hard to have a conversation about it without feeling attacked. Thank you.\"\u003c/p>\n\u003cp>This is what I have seen as I have covered the debate around SB 277. Those who fear vaccines were called stupid, anti-scientific or selfish -- which is unlikely to help improve vaccination rates, Witteman suggests. \"It may feel good to rant and rave, but people rarely change their minds because someone called them stupid and wrong.\"\u003c/p>\n\u003cp>Now it remains to be seen if requiring vaccines to attend school for all but those with a medical exemption will improve vaccination rates. Witteman says she's not opposed to the law, but in an email said she \"wonder(s) if it might backfire by increasing polarization, entrenching views, and driving parents who are vaccine hesitant further toward vaccine refusal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now a former Assemblyman has filed paperwork with the Office of the Attorney General for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/california-vaccine-debate-not-quite-over-tim-donnelly-files-referendum-to-overturn-new-law/\" target=\"_blank\">a referendum to overturn SB 277\u003c/a>. Backers of the law's repeal have until late September to gather 365,880 signatures to qualify for the Nov. 2016 ballot. If they are successful, the law will be put on hold until after the election.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/48802/engaging-vaccine-hesitant-parents-on-values-shared-decision-making","authors":["240"],"categories":["stateofhealth_11"],"tags":["stateofhealth_96","stateofhealth_236","stateofhealth_31"],"featImg":"stateofhealth_49947","label":"stateofhealth"},"stateofhealth_15820":{"type":"posts","id":"stateofhealth_15820","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"15820","score":null,"sort":[1382601776000]},"guestAuthors":[],"slug":"low-income-californians-want-to-be-engaged-patients-too-shared-decision-making","title":"Low-Income Californians Want To Be Engaged Patients, Too","publishDate":1382601776,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_15832\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/56292361-e1382588779517.jpg\">\u003cimg class=\"size-large wp-image-15832\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/56292361-640x417.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"417\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Only about one in four low-income Californians say they have easily comprehensible information for health decision-making, and 71 percent say they would like more. That's just one of the findings from a new\u003ca href=\"http://www.blueshieldcafoundation.org/programs/sub-program/innovation-and-performance/building-better-health-care-for-low-income-californians\" target=\"_blank\"> statewide survey\u003c/a> looking at \"opportunities and challenges\" in reaching this underserved population.\u003c/p>\n\u003cp>The report is the latest in \u003ca href=\"http://www.blueshieldcafoundation.org/programs/sub-program/innovation-and-performance\" target=\"_blank\">a series\u003c/a> from the Blue Shield of California Foundation and provides \"important insights for those working to reshape the system in California and for the rest of the country,\" foundation executive director Peter Long said at a briefing and panel discussion in Washington, D.C., on Wednesday.\u003c/p>\n\u003cp>When asked about their top source of health information, media sources (TV, internet, printed material) nudged out medical professionals, 39 percent to 38 percent. However, reliance on a medical provider for information goes up — by 22 percent — if the patient usually sees the same person.\u003c/p>\n\u003cp>From the report:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>Patients are also more apt to reply on their provider for information when they feel someone at their healthcare facility knows them (the definition of connectedness), as well as when providers explain things clearly, invite questions and encourage patients to be involved in their own care.\u003c/p>\u003c/blockquote>\n\u003cp>\"People often dismiss populations of lower income because they're different,\" said Dr. Kavita Patel, managing director of Delivery System Reform at the Brookings Institution, at the briefing on Wednesday. \"This study illustrates that no matter what your income is, patient engagement matters.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The survey is based on phone interviews with 1,018 Californians ages 19-64 with household incomes less than 200 percent of the \u003ca href=\"http://aspe.hhs.gov/poverty/13poverty.cfm\" target=\"_blank\">federal poverty level\u003c/a> (or about $46,000 for a family of four).\u003c/p>\n\u003cp>The report found that people with the strongest connection to their providers speak English and have insurance — which points to the challenge ahead in a state as diverse as California, as the Affordable Care Act is fully implemented on Jan. 1.\u003c/p>\n\u003cp>Yet the report also pointed to steps providers and health centers can take to engage their patients. In particular, patients who perceive that their provider encourages them to be active in their own care and feel that they have as much say in their health decisions as they want are significantly more likely to feel a \"strong rapport\" with their provider. They also feel \"very informed\" about their health and trust the doctor's information, according to the report.\u003c/p>\n\u003cp>Sara Rosenbaum, professor of health policy at the George Washington University School of Public Health, pointed out that \"it was no surprise to me that poor people should value good health care (as much as) anyone else does.\"\u003c/p>\n\u003cp>\u003cstrong>Digital divide\u003c/strong>\u003c/p>\n\u003cp>Though much has been written of the \u003ca href=\"http://www.pewinternet.org/Topics/Demographics/Digital-Divide.aspx?typeFilter=5\" target=\"_blank\">digital divide\u003c/a>, this new report teased out information that surprised even the panel. Four in 10 low-income Californians lack Internet access, the survey found, but that number spikes to 67 percent of low-income Spanish speakers.\u003c/p>\n\u003cp>Dr. Ron Yee worked for 20 years at United Health Centers, a group of community clinics in the Central Valley.\u003cstrong> \u003c/strong>\"I knew our patients did not have access to the Internet,\" he said at the briefing, \"but I was surprised to see 67 percent of our Spanish speakers did not have access. That's a big number for us to understand.\"\u003c/p>\n\u003cp>Of the people in the survey who use the Internet, three-quarters are interested in access to a health center's Internet patient portal. Of the few who have access, \"virtually all find it useful,\" the report found.\u003c/p>\n\u003cp>A similar disparity was found in email or text messages from providers. While very few low-income Californians have access to the technology, of those who do, 87 percent found email or text messages from the clinic or provider useful.\u003c/p>\n\u003cp>\u003cstrong>Alternative approaches\u003c/strong>\u003c/p>\n\u003cp>While California faces a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">shortage of primary care providers\u003c/a> at the moment when access to insurance is expanding, alternative approaches can help with access and communication. For example, team-based care where a patient may see a nurse practitioner or physician assistant or health navigators — people who help patients make their way through a hospital or clinic — can \"enhance, rather than diminish, the critical connection between patients and their providers,\" the report found.\u003c/p>\n\u003cp>\"Patients are ahead of policymakers here,\" Peter Long noted, adding that critics had said that expanding access would lead to greater demands on physicians. But low-income Californians \"are open to team care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We've heard a lot about mandates,\" Patel observed. \"This is the patient mandate. These folks were very clear about their aspirations. ... What they're willing to do if engaged to me is heartening.\"\u003c/p>\n\n","blocks":[],"excerpt":"Only about one in four low-income Californians say they have easily comprehensible information for health decision-making, and 71 percent say they would like more. That's just one of the findings from a new statewide survey looking at \"opportunities and challenges\" in reaching this underserved population.","status":"publish","parent":0,"modified":1386709735,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":769},"headData":{"title":"Low-Income Californians Want To Be Engaged Patients, Too | KQED","description":"Only about one in four low-income Californians say they have easily comprehensible information for health decision-making, and 71 percent say they would like more. That's just one of the findings from a new statewide survey looking at "opportunities and challenges" in reaching this underserved population.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Low-Income Californians Want To Be Engaged Patients, Too","datePublished":"2013-10-24T08:02:56.000Z","dateModified":"2013-12-10T21:08:55.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"15820 http://blogs.kqed.org/stateofhealth/?p=15820","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/10/24/low-income-californians-want-to-be-engaged-patients-too-shared-decision-making/","disqusTitle":"Low-Income Californians Want To Be Engaged Patients, Too","path":"/stateofhealth/15820/low-income-californians-want-to-be-engaged-patients-too-shared-decision-making","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15832\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/56292361-e1382588779517.jpg\">\u003cimg class=\"size-large wp-image-15832\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/56292361-640x417.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"417\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Only about one in four low-income Californians say they have easily comprehensible information for health decision-making, and 71 percent say they would like more. That's just one of the findings from a new\u003ca href=\"http://www.blueshieldcafoundation.org/programs/sub-program/innovation-and-performance/building-better-health-care-for-low-income-californians\" target=\"_blank\"> statewide survey\u003c/a> looking at \"opportunities and challenges\" in reaching this underserved population.\u003c/p>\n\u003cp>The report is the latest in \u003ca href=\"http://www.blueshieldcafoundation.org/programs/sub-program/innovation-and-performance\" target=\"_blank\">a series\u003c/a> from the Blue Shield of California Foundation and provides \"important insights for those working to reshape the system in California and for the rest of the country,\" foundation executive director Peter Long said at a briefing and panel discussion in Washington, D.C., on Wednesday.\u003c/p>\n\u003cp>When asked about their top source of health information, media sources (TV, internet, printed material) nudged out medical professionals, 39 percent to 38 percent. However, reliance on a medical provider for information goes up — by 22 percent — if the patient usually sees the same person.\u003c/p>\n\u003cp>From the report:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>Patients are also more apt to reply on their provider for information when they feel someone at their healthcare facility knows them (the definition of connectedness), as well as when providers explain things clearly, invite questions and encourage patients to be involved in their own care.\u003c/p>\u003c/blockquote>\n\u003cp>\"People often dismiss populations of lower income because they're different,\" said Dr. Kavita Patel, managing director of Delivery System Reform at the Brookings Institution, at the briefing on Wednesday. \"This study illustrates that no matter what your income is, patient engagement matters.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The survey is based on phone interviews with 1,018 Californians ages 19-64 with household incomes less than 200 percent of the \u003ca href=\"http://aspe.hhs.gov/poverty/13poverty.cfm\" target=\"_blank\">federal poverty level\u003c/a> (or about $46,000 for a family of four).\u003c/p>\n\u003cp>The report found that people with the strongest connection to their providers speak English and have insurance — which points to the challenge ahead in a state as diverse as California, as the Affordable Care Act is fully implemented on Jan. 1.\u003c/p>\n\u003cp>Yet the report also pointed to steps providers and health centers can take to engage their patients. In particular, patients who perceive that their provider encourages them to be active in their own care and feel that they have as much say in their health decisions as they want are significantly more likely to feel a \"strong rapport\" with their provider. They also feel \"very informed\" about their health and trust the doctor's information, according to the report.\u003c/p>\n\u003cp>Sara Rosenbaum, professor of health policy at the George Washington University School of Public Health, pointed out that \"it was no surprise to me that poor people should value good health care (as much as) anyone else does.\"\u003c/p>\n\u003cp>\u003cstrong>Digital divide\u003c/strong>\u003c/p>\n\u003cp>Though much has been written of the \u003ca href=\"http://www.pewinternet.org/Topics/Demographics/Digital-Divide.aspx?typeFilter=5\" target=\"_blank\">digital divide\u003c/a>, this new report teased out information that surprised even the panel. Four in 10 low-income Californians lack Internet access, the survey found, but that number spikes to 67 percent of low-income Spanish speakers.\u003c/p>\n\u003cp>Dr. Ron Yee worked for 20 years at United Health Centers, a group of community clinics in the Central Valley.\u003cstrong> \u003c/strong>\"I knew our patients did not have access to the Internet,\" he said at the briefing, \"but I was surprised to see 67 percent of our Spanish speakers did not have access. That's a big number for us to understand.\"\u003c/p>\n\u003cp>Of the people in the survey who use the Internet, three-quarters are interested in access to a health center's Internet patient portal. Of the few who have access, \"virtually all find it useful,\" the report found.\u003c/p>\n\u003cp>A similar disparity was found in email or text messages from providers. While very few low-income Californians have access to the technology, of those who do, 87 percent found email or text messages from the clinic or provider useful.\u003c/p>\n\u003cp>\u003cstrong>Alternative approaches\u003c/strong>\u003c/p>\n\u003cp>While California faces a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">shortage of primary care providers\u003c/a> at the moment when access to insurance is expanding, alternative approaches can help with access and communication. For example, team-based care where a patient may see a nurse practitioner or physician assistant or health navigators — people who help patients make their way through a hospital or clinic — can \"enhance, rather than diminish, the critical connection between patients and their providers,\" the report found.\u003c/p>\n\u003cp>\"Patients are ahead of policymakers here,\" Peter Long noted, adding that critics had said that expanding access would lead to greater demands on physicians. But low-income Californians \"are open to team care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We've heard a lot about mandates,\" Patel observed. \"This is the patient mandate. These folks were very clear about their aspirations. ... What they're willing to do if engaged to me is heartening.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/15820/low-income-californians-want-to-be-engaged-patients-too-shared-decision-making","authors":["240"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_236","stateofhealth_335"],"featImg":"stateofhealth_15832","label":"stateofhealth"},"stateofhealth_10710":{"type":"posts","id":"stateofhealth_10710","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"10710","score":null,"sort":[1361484020000]},"guestAuthors":[],"slug":"just-say-no-doctors-groups-define-more-unnecessary-tests-procedures","title":"Just Say No: Doctors' Groups Define More Unnecessary Tests, Procedures","publishDate":1361484020,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_10715\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/21/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures/ct-scan-13-of-clubs_flickr/\" rel=\"attachment wp-att-10715\">\u003cimg class=\"size-medium wp-image-10715\" title=\"Don't automatically do a CT scan on a child with a minor head injury. (13 of Clubs/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/CT-scan-13-of-Clubs_Flickr-300x225.jpg\" alt=\"CT scan 13 of Clubs_Flickr\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">One new recommendation: Don't automatically do a CT scan to check a child's minor head injury. (13 of Clubs/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\u003c/p>\n\u003cp>On Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit.\u003c/p>\n\u003cp>This \"\u003ca href=\"http://www.choosingwisely.org\" target=\"_blank\">Choosing Wisely\u003c/a>\" campaign is from a coalition of doctors' groups -- ranging from the American Academy of Pediatrics to the Society of Thoracic Surgeons -- in conjunction with Consumer Reports.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/05/please-dont-call-it-rationing/\" target=\"_blank\"> Last year\u003c/a>, the campaign named 45 tests and procedures patients should look at carefully. This year, 17 doctors' organizations representing 350,000 physicians released \u003ca href=\"http://www.choosingwisely.org/wp-content/uploads/2013/02/021513_CW-Phase-II-Press-Release-FINAL.pdf\" target=\"_blank\">90 additional tests and procedures.\u003c!--more-->\u003c/a>\u003c/p>\n\u003cp>The goal is to encourage patients and doctors to consider what care is truly necessary, to understand “that when it comes to health care, more is not necessarily better,” Dr. \u003ca href=\"http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_57.html\">Christine Cassel\u003c/a> of the ABIM Foundation said in a statement.\u003c/p>\n\u003cp>Here are just a few examples of some of their recommendations:\u003c/p>\n\u003cdiv>\n\u003cul>\n\u003cli>Don’t induce labor or schedule a c-section before 39 weeks pregnancy without a valid medical reason. Delivery before 39 weeks is associated with increased risk of learning disabilities and respiratory problems. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)\u003c/li>\n\u003cli>Don’t use feeding tubes in patients with advanced dementia. It does not result in better outcomes. Studies show that helping with eating is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)\u003c/li>\n\u003cli>Don’t automatically do a CT scan to check a child's minor head injury. Roughly half of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may increase future cancer risk. Doctor should observe a child prior to making a decision about needing a CT. (American Academy of Pediatrics)\u003c/li>\n\u003c/ul>\n\u003cp>Fifteen more medical societies are expected to release new or additional lists later this year.\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\r\n\r\nOn Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit. The goal is to encourage patients and doctors to consider what care is truly necessary.","status":"publish","parent":0,"modified":1361521394,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":8,"wordCount":370},"headData":{"title":"Just Say No: Doctors' Groups Define More Unnecessary Tests, Procedures | KQED","description":"One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\r\n\r\nOn Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit. The goal is to encourage patients and doctors to consider what care is truly necessary.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Just Say No: Doctors' Groups Define More Unnecessary Tests, Procedures","datePublished":"2013-02-21T22:00:20.000Z","dateModified":"2013-02-22T08:23:14.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"10710 http://blogs.kqed.org/stateofhealth/?p=10710","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/02/21/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures/","disqusTitle":"Just Say No: Doctors' Groups Define More Unnecessary Tests, Procedures","path":"/stateofhealth/10710/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10715\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/21/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures/ct-scan-13-of-clubs_flickr/\" rel=\"attachment wp-att-10715\">\u003cimg class=\"size-medium wp-image-10715\" title=\"Don't automatically do a CT scan on a child with a minor head injury. (13 of Clubs/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/CT-scan-13-of-Clubs_Flickr-300x225.jpg\" alt=\"CT scan 13 of Clubs_Flickr\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">One new recommendation: Don't automatically do a CT scan to check a child's minor head injury. (13 of Clubs/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\u003c/p>\n\u003cp>On Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit.\u003c/p>\n\u003cp>This \"\u003ca href=\"http://www.choosingwisely.org\" target=\"_blank\">Choosing Wisely\u003c/a>\" campaign is from a coalition of doctors' groups -- ranging from the American Academy of Pediatrics to the Society of Thoracic Surgeons -- in conjunction with Consumer Reports.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/05/please-dont-call-it-rationing/\" target=\"_blank\"> Last year\u003c/a>, the campaign named 45 tests and procedures patients should look at carefully. This year, 17 doctors' organizations representing 350,000 physicians released \u003ca href=\"http://www.choosingwisely.org/wp-content/uploads/2013/02/021513_CW-Phase-II-Press-Release-FINAL.pdf\" target=\"_blank\">90 additional tests and procedures.\u003c!--more-->\u003c/a>\u003c/p>\n\u003cp>The goal is to encourage patients and doctors to consider what care is truly necessary, to understand “that when it comes to health care, more is not necessarily better,” Dr. \u003ca href=\"http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_57.html\">Christine Cassel\u003c/a> of the ABIM Foundation said in a statement.\u003c/p>\n\u003cp>Here are just a few examples of some of their recommendations:\u003c/p>\n\u003cdiv>\n\u003cul>\n\u003cli>Don’t induce labor or schedule a c-section before 39 weeks pregnancy without a valid medical reason. Delivery before 39 weeks is associated with increased risk of learning disabilities and respiratory problems. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)\u003c/li>\n\u003cli>Don’t use feeding tubes in patients with advanced dementia. It does not result in better outcomes. Studies show that helping with eating is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)\u003c/li>\n\u003cli>Don’t automatically do a CT scan to check a child's minor head injury. Roughly half of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may increase future cancer risk. Doctor should observe a child prior to making a decision about needing a CT. (American Academy of Pediatrics)\u003c/li>\n\u003c/ul>\n\u003cp>Fifteen more medical societies are expected to release new or additional lists later this year.\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/10710/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_235","stateofhealth_236","stateofhealth_86"],"label":"stateofhealth"},"stateofhealth_8077":{"type":"posts","id":"stateofhealth_8077","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"8077","score":null,"sort":[1345141408000]},"guestAuthors":[],"slug":"in-medicine-dont-believe-everything-you-know","title":"In Medicine, Don't Believe Everything You Know","publishDate":1345141408,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_8104\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8104\" title=\"(Pmccormi: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr-300x225.jpg\" alt=\"(Pmccormi: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Pmccormi: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cp>How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. \u003cem>You\u003c/em> may think your doctor is right, but -- how does \u003cem>your doctor \u003c/em>know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\u003c/p>\n\u003cp>I recently joined in a robust, four-day discussion designed to address this issue at the \u003ca title=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" href=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" target=\"_blank\">14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care\u003c/a>. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.\u003c/p>\n\u003cp>In evidence based medicine, a hierarchy of evidence\u003cem> \u003c/em>guides decisions about patient care. But at the same time, evidence based medicine recognizes that \u003cem>evidence alone is not sufficient\u003c/em>. That's because treatment options come with risks, and different patients will react differently to different risks. It's not a simple matter of \"Drug X\" or \"Treatment Y\" has a five percent higher likelihood of success. If \"Treatment Y\" involves a risk or side effect a patient finds unacceptable, then this patient's preference is part of the decision process.\u003c/p>\n\u003cp>Decision makers \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" target=\"_blank\">must always acknowledge these trade offs\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The emphasis on patients’ considerations makes evidence based medicine a patient-centered practice, ideal for the coming age of healthcare reform. It’s imperative that both providers and patients learn to properly evaluate their sources of medical information. Even tougher -- old habits die hard, as we all know. Earlier this year in the \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" target=\"_blank\">Journal of the American Medical Association\u003c/a>, Stanford professor \u003ca href=\"http://med.stanford.edu/profiles/John_Ioannidis/\">John Ioannidis\u003c/a> (and others) wrote of just how hard it is to reverse established medical practice:\u003c/p>\n\u003cblockquote>\u003cp>\u003cem>\u003c/em>Ideally, good medical practices are replaced by better ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however … what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain.\u003c/p>\u003c/blockquote>\n\u003cp>Factors beyond science -- including bias -- can alter the outcome of a study. They can even affect what research is conducted and published. Ioannidis is well known for exposing ways this happens and why it is harmful to patients and physicians.\u003c/p>\n\u003cp>One take-away from the workshop I particularly endorse came from the U.S. Preventive Services Task Force chair \u003ca href=\"http://www.uspreventiveservicestaskforce.org/tflongbios.htm\">Virginia Moyer\u003c/a>: researchers should stop designing research around outcomes that don't matter to patients! One example we discussed was bone density. What patients care about is preventing fractures. But studies looked at bone density, believing bone density was linked to fractures. Turns out it's not. In this case, studies that look at fractures are what's needed.\u003c/p>\n\u003cp>But overall it appears that patient perspectives and values are increasingly part of research design. The Patient Centered Outcomes Research Institute (PCORI) is funding innovative new studies. In a recent article, PCORI explains \"\u003ca href=\"http://www.pcori.org/blog/why-methods-matter/\" target=\"_blank\">Why Methods Matter\u003c/a>.\" Today, patients have more treatment options than ever, and changes in the way we receive our healthcare today – shorter hospital stays, for example -- may affect outcomes. So although difficult, it’s crucial for patients and providers to understand and use the most relevant information when making decisions.\u003c/p>\n\u003cp>Doctors and patients are making progress in defining and trying out new ways of communicating about treatment decisions. Achieving the best outcomes via this newer, more participatory practice of medicine requires attention not only to the evidence provided by high quality studies but also clinical judgment and the bottom line: patient values.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. You may think your doctor is right, but -- how does your doctor know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\r\n\r\nI recently joined in a robust, four-day discussion designed to address this issue at the 14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, or evidence based medicine.","status":"publish","parent":0,"modified":1345229814,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":650},"headData":{"title":"In Medicine, Don't Believe Everything You Know | KQED","description":"How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. You may think your doctor is right, but -- how does your doctor know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\r\n\r\nI recently joined in a robust, four-day discussion designed to address this issue at the 14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, or evidence based medicine.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In Medicine, Don't Believe Everything You Know","datePublished":"2012-08-16T18:23:28.000Z","dateModified":"2012-08-17T18:56:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"8077 http://blogs.kqed.org/stateofhealth/?p=8077","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/08/16/in-medicine-dont-believe-everything-you-know/","disqusTitle":"In Medicine, Don't Believe Everything You Know","path":"/stateofhealth/8077/in-medicine-dont-believe-everything-you-know","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8104\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8104\" title=\"(Pmccormi: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr-300x225.jpg\" alt=\"(Pmccormi: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Pmccormi: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cp>How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. \u003cem>You\u003c/em> may think your doctor is right, but -- how does \u003cem>your doctor \u003c/em>know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\u003c/p>\n\u003cp>I recently joined in a robust, four-day discussion designed to address this issue at the \u003ca title=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" href=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" target=\"_blank\">14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care\u003c/a>. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.\u003c/p>\n\u003cp>In evidence based medicine, a hierarchy of evidence\u003cem> \u003c/em>guides decisions about patient care. But at the same time, evidence based medicine recognizes that \u003cem>evidence alone is not sufficient\u003c/em>. That's because treatment options come with risks, and different patients will react differently to different risks. It's not a simple matter of \"Drug X\" or \"Treatment Y\" has a five percent higher likelihood of success. If \"Treatment Y\" involves a risk or side effect a patient finds unacceptable, then this patient's preference is part of the decision process.\u003c/p>\n\u003cp>Decision makers \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" target=\"_blank\">must always acknowledge these trade offs\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The emphasis on patients’ considerations makes evidence based medicine a patient-centered practice, ideal for the coming age of healthcare reform. It’s imperative that both providers and patients learn to properly evaluate their sources of medical information. Even tougher -- old habits die hard, as we all know. Earlier this year in the \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" target=\"_blank\">Journal of the American Medical Association\u003c/a>, Stanford professor \u003ca href=\"http://med.stanford.edu/profiles/John_Ioannidis/\">John Ioannidis\u003c/a> (and others) wrote of just how hard it is to reverse established medical practice:\u003c/p>\n\u003cblockquote>\u003cp>\u003cem>\u003c/em>Ideally, good medical practices are replaced by better ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however … what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain.\u003c/p>\u003c/blockquote>\n\u003cp>Factors beyond science -- including bias -- can alter the outcome of a study. They can even affect what research is conducted and published. Ioannidis is well known for exposing ways this happens and why it is harmful to patients and physicians.\u003c/p>\n\u003cp>One take-away from the workshop I particularly endorse came from the U.S. Preventive Services Task Force chair \u003ca href=\"http://www.uspreventiveservicestaskforce.org/tflongbios.htm\">Virginia Moyer\u003c/a>: researchers should stop designing research around outcomes that don't matter to patients! One example we discussed was bone density. What patients care about is preventing fractures. But studies looked at bone density, believing bone density was linked to fractures. Turns out it's not. In this case, studies that look at fractures are what's needed.\u003c/p>\n\u003cp>But overall it appears that patient perspectives and values are increasingly part of research design. The Patient Centered Outcomes Research Institute (PCORI) is funding innovative new studies. In a recent article, PCORI explains \"\u003ca href=\"http://www.pcori.org/blog/why-methods-matter/\" target=\"_blank\">Why Methods Matter\u003c/a>.\" Today, patients have more treatment options than ever, and changes in the way we receive our healthcare today – shorter hospital stays, for example -- may affect outcomes. So although difficult, it’s crucial for patients and providers to understand and use the most relevant information when making decisions.\u003c/p>\n\u003cp>Doctors and patients are making progress in defining and trying out new ways of communicating about treatment decisions. Achieving the best outcomes via this newer, more participatory practice of medicine requires attention not only to the evidence provided by high quality studies but also clinical judgment and the bottom line: patient values.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/8077/in-medicine-dont-believe-everything-you-know","authors":["8372"],"categories":["stateofhealth_12","stateofhealth_14"],"tags":["stateofhealth_344","stateofhealth_236"],"featImg":"stateofhealth_8104","label":"stateofhealth"},"stateofhealth_7367":{"type":"posts","id":"stateofhealth_7367","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"7367","score":null,"sort":[1343327172000]},"guestAuthors":[],"slug":"primary-care-efforts-to-involve-patients-in-decision-making","title":"Primary Care Efforts to Involve Patients in Decision Making","publishDate":1343327172,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_7616\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/Doctor_Patient_MercyHealth_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7616\" title=\"(Mercy Health: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/Doctor_Patient_MercyHealth_Flickr-300x256.jpg\" alt=\"(Mercy Health: Flickr)\" width=\"300\" height=\"256\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Mercy Health: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>All day, every day, people make medical choices that have repercussions for common yet dangerous conditions like asthma, heart disease and diabetes. Although chronic disease takes a \u003ca title=\"http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP-BurdenReport-LowRes.pdf\" href=\"http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP-BurdenReport-LowRes.pdf\" target=\"_blank\">greater toll\u003c/a> [PDF] on people with lower socioeconomic status, chronically ill patients are part of every community. In California and across the country, public health officials and physicians keep searching for the best way to get patients involved in improving their health.\u003c/p>\n\u003cp>Some patients naturally want to be \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" href=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" target=\"_blank\">involved with their care\u003c/a>. Other times it's doctors and nurses who must try to encourage more engagement by their patients. “Whether to exercise or change their diet, take medication,\" \u003ca title=\"http://familymedicine.medschool.ucsf.edu/faculty/bios/thom_d.aspx\" href=\"http://familymedicine.medschool.ucsf.edu/faculty/bios/thom_d.aspx\" target=\"_blank\">Dr. David Thom\u003c/a> told me recently, \"those are the bread and butter decisions that go into primary care.\"\u003c/p>\n\u003cp>Thom, director of research in the UC San Francisco department of Family and Community Medicine, is launching a new study, exploring how patients make decisions when they work with a “health coach.\" Often health coaches are trained medical assistants who join the primary care team. “Our belief is that health coaches are going to have a fairly different relationship with patients than providers do,” he says. “Their role in helping the patients make decisions will be clearly different than the providers’ role.”\u003c!--more-->\u003c/p>\n\u003cp>For example, coaches may help patients prepare questions in order to make the best use of limited face time with their doctors. Coaches might also accompany patients to appointments or help them navigate between multiple departments in a medical center.\u003c/p>\n\u003cp>Many \u003ca title=\"http://www.naph.org/Homepage-Sections/Explore/Innovations/Minority-Health/SFGH-Language-Concordant-Health-Coaches.aspx\" href=\"http://www.naph.org/Homepage-Sections/Explore/Innovations/Minority-Health/SFGH-Language-Concordant-Health-Coaches.aspx\" target=\"_blank\">coaches\u003c/a> are bilingual and for Thom's research some are already trained and in place. \u003ca href=\"http://www.mnhc.org/\" target=\"_blank\">Mission Neighborhood Health Center\u003c/a> and \u003ca href=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/hlthCtrs/SEHlthCtr.asp\" target=\"_blank\">Southeast Health Center\u003c/a>, both part of the healthcare safety net in San Francisco, will be the first sites studied. Coaches meet with patients and sometimes patients’ families, follow up on the phone, and sometimes sit in on appointments. They have access to the doctors and other members of the primary care team.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As part of the \u003ca title=\"http://www.healthcare.gov\" href=\"http://www.healthcare.gov\" target=\"_blank\">Affordable Care Act\u003c/a>, the federal health care overhaul, patient engagement is linked to reimbursement for providers. Hospitals and outpatient providers alike have new incentives to successfully educate their patients and demonstrate that their patients are participating in their own treatment. With a two-year grant from the newly formed \u003ca href=\"http://www.pcori.org/\" target=\"_blank\">Patient-Centered Outcomes Research Institute \u003c/a>the UCSF researchers hope to discover which elements of coaching improve patients’ abilities to make medical decisions, improve clinical practice and improve the patient's experience of care. \u003cem>\u003c/em>\u003c/p>\n\u003cp>And it's not just safety net patients who can benefit from coaches. In the heart of Silicon Valley, researchers studied a group of patients to determine how confidently patients were engaged in discussing their care with their healthcare providers.\u003c/p>\n\u003cp>Nearly all the patients in \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" target=\"_blank\">this study\u003c/a> by the\u003ca title=\"http://www.pamf.org/\" href=\"http://www.pamf.org/\" target=\"_blank\"> Palo Alto Medical Foundation\u003c/a> (PAMF) were well-educated and had health insurance. More than a third had a chronic illness. These patients could easily envision asking questions and discussing preferences with their doctors. About 70 percent said they preferred a shared decision-making role, one in which patients and doctors contribute equally to medical decisions.\u003c/p>\n\u003cp>But drill down a bit more and that shared decision-making gets more difficult. Only 14 percent of patients said they would \"voice disagreement\" with their doctor if their own preferences conflicted with the doctor's recommendations.\u003c/p>\n\u003cp>According to PAMF researchers, patients want to participate with their physicians in decision-making, but worry they might be perceived as “difficult” and that their care in the future would be compromised.\u003c/p>\n\u003cp>Forget the future -- patients' care might be compromised right now, if they disagree with a recommended treatment, but say nothing. \"Reluctance to express disagreement in the office may correlate with poor adherence outside the office,\" the researchers noted. \"The findings point to the need to test interventions that explicitly allow patients to voice disagreement with their physicians.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"All day, every day, people make medical choices that have repercussions for common yet dangerous conditions like asthma, heart disease and diabetes. Although chronic disease takes a greater toll [PDF] on people with lower socioeconomic status, chronically ill patients are part of every community. In California and across the country, public health officials and physicians keep searching for the best way to get patients involved in improving their health. Some patients naturally want to be involved with their care. Other times it's doctors and nurses who must try to encourage more engagement by their patients.\r\n\r\n“Whether to exercise or change their diet, take medication,\" Dr. David Thom told me recently, \"those are the bread and butter decisions that go into primary care.\"","status":"publish","parent":0,"modified":1343332657,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":679},"headData":{"title":"Primary Care Efforts to Involve Patients in Decision Making | KQED","description":"All day, every day, people make medical choices that have repercussions for common yet dangerous conditions like asthma, heart disease and diabetes. Although chronic disease takes a greater toll on people with lower socioeconomic status, chronically ill patients are part of every community. In California and across the country, public health officials and physicians keep searching for the best way to get patients involved in improving their health. Some patients naturally want to be involved with their care. Other times it's doctors and nurses who must try to encourage more engagement by their patients.\r\n\r\n“Whether to exercise or change their diet, take medication," Dr. David Thom told me recently, "those are the bread and butter decisions that go into primary care."","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Primary Care Efforts to Involve Patients in Decision Making","datePublished":"2012-07-26T18:26:12.000Z","dateModified":"2012-07-26T19:57:37.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"7367 http://blogs.kqed.org/stateofhealth/?p=7367","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/07/26/primary-care-efforts-to-involve-patients-in-decision-making/","disqusTitle":"Primary Care Efforts to Involve Patients in Decision Making","path":"/stateofhealth/7367/primary-care-efforts-to-involve-patients-in-decision-making","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_7616\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/Doctor_Patient_MercyHealth_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7616\" title=\"(Mercy Health: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/Doctor_Patient_MercyHealth_Flickr-300x256.jpg\" alt=\"(Mercy Health: Flickr)\" width=\"300\" height=\"256\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Mercy Health: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>All day, every day, people make medical choices that have repercussions for common yet dangerous conditions like asthma, heart disease and diabetes. Although chronic disease takes a \u003ca title=\"http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP-BurdenReport-LowRes.pdf\" href=\"http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP-BurdenReport-LowRes.pdf\" target=\"_blank\">greater toll\u003c/a> [PDF] on people with lower socioeconomic status, chronically ill patients are part of every community. In California and across the country, public health officials and physicians keep searching for the best way to get patients involved in improving their health.\u003c/p>\n\u003cp>Some patients naturally want to be \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" href=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" target=\"_blank\">involved with their care\u003c/a>. Other times it's doctors and nurses who must try to encourage more engagement by their patients. “Whether to exercise or change their diet, take medication,\" \u003ca title=\"http://familymedicine.medschool.ucsf.edu/faculty/bios/thom_d.aspx\" href=\"http://familymedicine.medschool.ucsf.edu/faculty/bios/thom_d.aspx\" target=\"_blank\">Dr. David Thom\u003c/a> told me recently, \"those are the bread and butter decisions that go into primary care.\"\u003c/p>\n\u003cp>Thom, director of research in the UC San Francisco department of Family and Community Medicine, is launching a new study, exploring how patients make decisions when they work with a “health coach.\" Often health coaches are trained medical assistants who join the primary care team. “Our belief is that health coaches are going to have a fairly different relationship with patients than providers do,” he says. “Their role in helping the patients make decisions will be clearly different than the providers’ role.”\u003c!--more-->\u003c/p>\n\u003cp>For example, coaches may help patients prepare questions in order to make the best use of limited face time with their doctors. Coaches might also accompany patients to appointments or help them navigate between multiple departments in a medical center.\u003c/p>\n\u003cp>Many \u003ca title=\"http://www.naph.org/Homepage-Sections/Explore/Innovations/Minority-Health/SFGH-Language-Concordant-Health-Coaches.aspx\" href=\"http://www.naph.org/Homepage-Sections/Explore/Innovations/Minority-Health/SFGH-Language-Concordant-Health-Coaches.aspx\" target=\"_blank\">coaches\u003c/a> are bilingual and for Thom's research some are already trained and in place. \u003ca href=\"http://www.mnhc.org/\" target=\"_blank\">Mission Neighborhood Health Center\u003c/a> and \u003ca href=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/hlthCtrs/SEHlthCtr.asp\" target=\"_blank\">Southeast Health Center\u003c/a>, both part of the healthcare safety net in San Francisco, will be the first sites studied. Coaches meet with patients and sometimes patients’ families, follow up on the phone, and sometimes sit in on appointments. They have access to the doctors and other members of the primary care team.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As part of the \u003ca title=\"http://www.healthcare.gov\" href=\"http://www.healthcare.gov\" target=\"_blank\">Affordable Care Act\u003c/a>, the federal health care overhaul, patient engagement is linked to reimbursement for providers. Hospitals and outpatient providers alike have new incentives to successfully educate their patients and demonstrate that their patients are participating in their own treatment. With a two-year grant from the newly formed \u003ca href=\"http://www.pcori.org/\" target=\"_blank\">Patient-Centered Outcomes Research Institute \u003c/a>the UCSF researchers hope to discover which elements of coaching improve patients’ abilities to make medical decisions, improve clinical practice and improve the patient's experience of care. \u003cem>\u003c/em>\u003c/p>\n\u003cp>And it's not just safety net patients who can benefit from coaches. In the heart of Silicon Valley, researchers studied a group of patients to determine how confidently patients were engaged in discussing their care with their healthcare providers.\u003c/p>\n\u003cp>Nearly all the patients in \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" target=\"_blank\">this study\u003c/a> by the\u003ca title=\"http://www.pamf.org/\" href=\"http://www.pamf.org/\" target=\"_blank\"> Palo Alto Medical Foundation\u003c/a> (PAMF) were well-educated and had health insurance. More than a third had a chronic illness. These patients could easily envision asking questions and discussing preferences with their doctors. About 70 percent said they preferred a shared decision-making role, one in which patients and doctors contribute equally to medical decisions.\u003c/p>\n\u003cp>But drill down a bit more and that shared decision-making gets more difficult. Only 14 percent of patients said they would \"voice disagreement\" with their doctor if their own preferences conflicted with the doctor's recommendations.\u003c/p>\n\u003cp>According to PAMF researchers, patients want to participate with their physicians in decision-making, but worry they might be perceived as “difficult” and that their care in the future would be compromised.\u003c/p>\n\u003cp>Forget the future -- patients' care might be compromised right now, if they disagree with a recommended treatment, but say nothing. \"Reluctance to express disagreement in the office may correlate with poor adherence outside the office,\" the researchers noted. \"The findings point to the need to test interventions that explicitly allow patients to voice disagreement with their physicians.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/7367/primary-care-efforts-to-involve-patients-in-decision-making","authors":["8372"],"categories":["stateofhealth_12","stateofhealth_14"],"tags":["stateofhealth_37","stateofhealth_236"],"featImg":"stateofhealth_7616","label":"stateofhealth"},"stateofhealth_7328":{"type":"posts","id":"stateofhealth_7328","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"7328","score":null,"sort":[1343083624000]},"guestAuthors":[],"slug":"what-do-engaged-patients-do","title":"What Do 'Engaged' Patients Do? ","publishDate":1343083624,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_7553\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7553\" title=\"(Seattle Municipal Archives: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr-300x197.jpg\" alt=\"(Seattle Municipal Archives: Flickr)\" width=\"300\" height=\"197\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Seattle Municipal Archives: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Desiree Basila was 52 when her stage zero breast cancer -- also called ductal carcinoma in situ -- was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, doctors said her only realistic treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that,\" she told me recently. \"I did not really want to have a double mastectomy.\"\u003c/p>\n\u003cp>Basila is strong evidence that individuals react differently to their treatment choices\u003cem>. \u003c/em>The new healthcare buzzword is the \u003cem>engaged\u003c/em> patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.\u003c/p>\n\u003cp>Basila became just such an engaged patient. After a cancer diagnosis, people usually have a few weeks to investigate treatment options, options that may be life altering. While Basila had little prior experience with cancer, she had been a science teacher and put her skills to use, digging into the research. She sought a second opinion at UC San Francisco and discovered a new \u003c!--more-->research trial which appealed to her. Instead of double mastectomy, she enrolled in a trial on \"\u003ca title=\"http://www.cancer.gov/dictionary?cdrid=616060\" href=\"http://www.cancer.gov/dictionary?cdrid=616060\" target=\"_blank\">Active Surveillance\u003c/a>\" of her slow-growing cancer. As part of the trial, she would go in twice a year for mammograms and she also received MRI images of her breasts once a year. “If it starts showing signs of aggression we can catch it and start more treatment at that point,” she said.\u003c/p>\n\u003cp>In addition to the trial, Basila had support from the \u003ca href=\"http://www.decisionservices.ucsf.edu/\" target=\"_blank\">Decision Services\u003c/a> group at UCSF. There, a newly-diagnosed cancer patient can elect to work with specially trained interns. These interns are often recent college graduates on their way to medical school or other health professions. They help patients find and review accurate information, determine their priorities, and create lists of questions. An intern may also accompany a patient as a note taker during medical appointments.\u003c/p>\n\u003cp>Such strategies have been been shown to improve patients’ understanding of their cancer as well as their sense of engagement in their care. In a \u003ca title=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" href=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" target=\"_blank\">pilot program,\u003c/a> [PDF] nine out of ten patients felt that the list of questions, concerns and expectations contributed to a more productive appointment with their doctor. Both patients and physicians reported satisfaction with these techniques.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But this decision support was available only to a fraction of the nation’s cancer patients until earlier this summer, when the \u003cem>Open to Options\u003c/em>\u003ca href=\"http://www.cancersupportcommunity.org/MainMenu/About-Cancer/Treatment/Making-a-Treatment-Decision/Open-to-Options-2\" target=\"_blank\"> program\u003c/a> was launched by the \u003ca href=\"http://www.cancersupportcommunity.org/\" target=\"_blank\">Cancer Support Community\u003c/a>. This new program was inspired by UCSF’s decision-support service, and its counselors were trained by\u003ca title=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" href=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" target=\"_blank\"> Professor Jeffrey Belkora\u003c/a>, Director of Decision Services for the UCSF Breast Care Center.\u003c/p>\n\u003cp>The nonprofit Cancer Support Community (CSC) has a network of 150 locations across the country. The \u003cem>Open to Options \u003c/em>program adds a toll-free phone number and other engagement tools to dramatically expand the reach of the services.\u003c/p>\n\u003cp>The new program targets patients who are “newly diagnosed, facing recurrence or at some other point during their survivorship when they’re faced with making decisions,” Belkora said. “After diagnosis but before treatment is a very vulnerable time for people. … They’re overloaded and overwhelmed.\"\u003c/p>\n\u003cp>Meanwhile, it's been five years since the self-described “risk-tolerant” Basila made her own decision. She admits her background in science made her diagnosis somewhat less confusing for her. After collaborating with decision-support interns, Basila said she felt she could “ask the right questions and give real thought to the answers. ... I didn’t want my decision to be a reaction to fear.\" Although she lives with an “ongoing process” of decision, she hasn’t wavered for the past five years. Her early stage breast cancer has not progressed and she is \"thrilled\" with her choice.\u003c/p>\n\u003cp>Active surveillance is common in prostate cancer but considered experimental for breast cancer. The outcome, while under study, is unknown. “Every one of us,” Basila said, “has to decide what will be our quality vs. quantity of life.”\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This blog has been updated to remove estimates of how many people might be served by the new service.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area health writer. Check out her blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Desiree Basila was 52 when her stage zero breast cancer was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, this meant her only treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that,\" she told me recently. \"I did not really want to have a double mastectomy.\"\r\n\r\nBasila is strong evidence that individuals react differently to their treatment choices. The new healthcare buzzword is the engaged patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.","status":"publish","parent":0,"modified":1343865687,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":758},"headData":{"title":"What Do 'Engaged' Patients Do? | KQED","description":"Desiree Basila was 52 when her stage zero breast cancer was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, this meant her only treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that," she told me recently. "I did not really want to have a double mastectomy."\r\n\r\nBasila is strong evidence that individuals react differently to their treatment choices. The new healthcare buzzword is the engaged patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"What Do 'Engaged' Patients Do? ","datePublished":"2012-07-23T22:47:04.000Z","dateModified":"2012-08-02T00:01:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"7328 http://blogs.kqed.org/stateofhealth/?p=7328","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/","disqusTitle":"What Do 'Engaged' Patients Do? ","path":"/stateofhealth/7328/what-do-engaged-patients-do","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_7553\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7553\" title=\"(Seattle Municipal Archives: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr-300x197.jpg\" alt=\"(Seattle Municipal Archives: Flickr)\" width=\"300\" height=\"197\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Seattle Municipal Archives: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Desiree Basila was 52 when her stage zero breast cancer -- also called ductal carcinoma in situ -- was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, doctors said her only realistic treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that,\" she told me recently. \"I did not really want to have a double mastectomy.\"\u003c/p>\n\u003cp>Basila is strong evidence that individuals react differently to their treatment choices\u003cem>. \u003c/em>The new healthcare buzzword is the \u003cem>engaged\u003c/em> patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.\u003c/p>\n\u003cp>Basila became just such an engaged patient. After a cancer diagnosis, people usually have a few weeks to investigate treatment options, options that may be life altering. While Basila had little prior experience with cancer, she had been a science teacher and put her skills to use, digging into the research. She sought a second opinion at UC San Francisco and discovered a new \u003c!--more-->research trial which appealed to her. Instead of double mastectomy, she enrolled in a trial on \"\u003ca title=\"http://www.cancer.gov/dictionary?cdrid=616060\" href=\"http://www.cancer.gov/dictionary?cdrid=616060\" target=\"_blank\">Active Surveillance\u003c/a>\" of her slow-growing cancer. As part of the trial, she would go in twice a year for mammograms and she also received MRI images of her breasts once a year. “If it starts showing signs of aggression we can catch it and start more treatment at that point,” she said.\u003c/p>\n\u003cp>In addition to the trial, Basila had support from the \u003ca href=\"http://www.decisionservices.ucsf.edu/\" target=\"_blank\">Decision Services\u003c/a> group at UCSF. There, a newly-diagnosed cancer patient can elect to work with specially trained interns. These interns are often recent college graduates on their way to medical school or other health professions. They help patients find and review accurate information, determine their priorities, and create lists of questions. An intern may also accompany a patient as a note taker during medical appointments.\u003c/p>\n\u003cp>Such strategies have been been shown to improve patients’ understanding of their cancer as well as their sense of engagement in their care. In a \u003ca title=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" href=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" target=\"_blank\">pilot program,\u003c/a> [PDF] nine out of ten patients felt that the list of questions, concerns and expectations contributed to a more productive appointment with their doctor. Both patients and physicians reported satisfaction with these techniques.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But this decision support was available only to a fraction of the nation’s cancer patients until earlier this summer, when the \u003cem>Open to Options\u003c/em>\u003ca href=\"http://www.cancersupportcommunity.org/MainMenu/About-Cancer/Treatment/Making-a-Treatment-Decision/Open-to-Options-2\" target=\"_blank\"> program\u003c/a> was launched by the \u003ca href=\"http://www.cancersupportcommunity.org/\" target=\"_blank\">Cancer Support Community\u003c/a>. This new program was inspired by UCSF’s decision-support service, and its counselors were trained by\u003ca title=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" href=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" target=\"_blank\"> Professor Jeffrey Belkora\u003c/a>, Director of Decision Services for the UCSF Breast Care Center.\u003c/p>\n\u003cp>The nonprofit Cancer Support Community (CSC) has a network of 150 locations across the country. The \u003cem>Open to Options \u003c/em>program adds a toll-free phone number and other engagement tools to dramatically expand the reach of the services.\u003c/p>\n\u003cp>The new program targets patients who are “newly diagnosed, facing recurrence or at some other point during their survivorship when they’re faced with making decisions,” Belkora said. “After diagnosis but before treatment is a very vulnerable time for people. … They’re overloaded and overwhelmed.\"\u003c/p>\n\u003cp>Meanwhile, it's been five years since the self-described “risk-tolerant” Basila made her own decision. She admits her background in science made her diagnosis somewhat less confusing for her. After collaborating with decision-support interns, Basila said she felt she could “ask the right questions and give real thought to the answers. ... I didn’t want my decision to be a reaction to fear.\" Although she lives with an “ongoing process” of decision, she hasn’t wavered for the past five years. Her early stage breast cancer has not progressed and she is \"thrilled\" with her choice.\u003c/p>\n\u003cp>Active surveillance is common in prostate cancer but considered experimental for breast cancer. The outcome, while under study, is unknown. “Every one of us,” Basila said, “has to decide what will be our quality vs. quantity of life.”\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This blog has been updated to remove estimates of how many people might be served by the new service.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area health writer. Check out her blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/7328/what-do-engaged-patients-do","authors":["8372"],"categories":["stateofhealth_12"],"tags":["stateofhealth_46","stateofhealth_236"],"featImg":"stateofhealth_7553","label":"stateofhealth"},"stateofhealth_5390":{"type":"posts","id":"stateofhealth_5390","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"5390","score":null,"sort":[1335389069000]},"guestAuthors":[],"slug":"shared-decision-making","title":"Share and Share Alike -- Especially in Medical Decisions","publishDate":1335389069,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5398\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatient_Caroline_1_Flickr_04252012.jpg\">\u003cimg class=\"size-medium wp-image-5398\" title=\"(Caroline_1: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatient_Caroline_1_Flickr_04252012-300x200.jpg\" alt=\"(Caroline_1: Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Caroline_1: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Patients often make decisions about their medical treatment while sitting on an exam table in a thin cotton gown. But is this the best way to fully understand your options? Of course, some healthcare decisions are pretty easy. For example, if the treatment being offered is easy to use or has a long history of success with only mild side effects.\u003c/p>\n\u003cp>But overall, health care decisions are becoming more complex. Your doctor may offer more than one alternative. Picking among those alternatives may have as much to do with medical evidence as your own preferences. The process known as \u003ca title=\"http://patients.dartmouth-hitchcock.org/shared_decision_making/about_shared_decision_making.html\" href=\"http://patients.dartmouth-hitchcock.org/shared_decision_making/about_shared_decision_making.html\" target=\"_blank\">\u003cem>shared decision making\u003c/em> \u003c/a>empowers patients to collaborate with their doctors in choosing a treatment, as opposed to the doctor pointing a patient toward one choice.\u003c/p>\n\u003caside class=\"pullquote alignright\">“We have an ethical duty to inform our patients what their options are and get their preferences.”\u003c/aside>\n\u003cp>It all has to do with risks and benefits. In a shared decision process doctors put more effort into explaining trade-offs, and patients must think more deeply about what matters most to them. The relationship of shared decision making to better health is still being studied, but \u003ca title=\"https://www.cahps.ahrq.gov/Quality-Improvement/Improvement-Guide/Browse-Interventions/Communication/Shared-Decision-Making.aspx\" href=\"https://www.cahps.ahrq.gov/Quality-Improvement/Improvement-Guide/Browse-Interventions/Communication/Shared-Decision-Making.aspx\" target=\"_blank\">we know\u003c/a> that patients who are involved in making their own medical decisions often have less anxiety and recover more quickly.\u003c!--more-->\u003c/p>\n\u003cp>Patient advocates embrace this approach and doctors increasingly see the importance of collaboration, too. “We have an ethical duty to inform our patients what their options are and get their preferences,” \u003ca href=\"http://cet.usc.edu/faculty/may.html\" target=\"_blank\">Dr. Win May\u003c/a> told me. May is a professor at USC’s Keck School of Medicine. “Even with surgical interventions,” she said, “one can always ask ‘can we wait?’”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Case in point: Marcy Baskin. She’s 60 and two years ago was suffering “excruciating” arthritis pain. But despite the pain, she took several months to decide on surgery to replace her arthritic ankle with a prosthesis.\u003c/p>\n\u003cp>Baskin is a yoga practitioner and former personal trainer who values her active lifestyle. She lives in rural Sonoma County with a horse, some chickens, her husband and close family nearby.\u003c/p>\n\u003cp>She met several times face to face with her surgeon and sent “at least a dozen” emails, she told me. Even after the surgeon answered her emails and told her that 85 percent of patients recover well, Baskin feared a bad outcome. She talked with her husband and sister, because “that’s the nature of my family, we talk about stuff like that.” Now 16 months post-op, she is confident she made the right choice in the right way. “I’m engaged in every other decision in my life, why not with my body?”\u003c/p>\n\u003cp>Best-selling author\u003ca title=\"http://www.jeromegroopman.com/\" href=\"http://www.jeromegroopman.com/\" target=\"_blank\"> Dr. Jerome Groopman \u003c/a>told \u003ca title=\"http://www.npr.org/2011/09/21/140438982/becoming-mindful-of-medical-decision-making\" href=\"http://www.npr.org/2011/09/21/140438982/becoming-mindful-of-medical-decision-making\" target=\"_blank\">Fresh Air’s Terry Gross\u003c/a>, “It's very important for people to understand how the (medical) information applies to them as individuals and then to understand ... their own personal approach to making choices ... so that they're confident that what they chose is right for them.\"\u003c/p>\n\u003cp>Groopman and co-author Dr. Pamela Hartzband explain in their book “\u003cem>\u003ca title=\"http://yourmedicalmind.com/index.html\" href=\"http://yourmedicalmind.com/index.html\" target=\"_blank\">Your Medical Mind\u003c/a>\u003c/em>” how our varied personalities affect our decision making. Some people, for example, need to hear about the experiences of other patients in order to truly understand how the treatment (or lack of treatment) will feel. Patients increasingly are reaching out through social media to others with similar diagnoses, hoping to find information or help \u003cem>. \u003c/em>\u003c/p>\n\u003cp>Even if most patients now want more information, and many want greater involvement in decision making, there is a gap. Dr. May says that underrepresented minority patients and those of lower socioeconomic status ask fewer questions. But she insists there is a way to involve practically any patient. “We know that when people have low self esteem they defer (to the provider) but the provider can encourage them.”\u003c/p>\n\u003cp>A small \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/art.22670/pdf\">2007 study\u003c/a> from UCLA demonstrated a way to reduce one such disparity. African Americans suffering arthritis pain have knee replacement surgery significantly less often than Caucasians. This treatment disparity has been linked to a difference in knowledge and expectations of the surgery. Many more African Americans say they expect pain and decreased mobility to continue after recovery from the operation. In the UCLA study, researchers leveled the playing field by showing an educational video during small group meetings. Afterward, expectation of a poor outcome fell among African Americans. All attendees showed the same understanding about the risk and benefit of knee replacement.\u003c/p>\n\u003cp>Moving patients toward greater responsibility overall for their health will take time. May said “There are cultural issues we need to solve -- that’s what we all aspire to.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area health writer. Check out her blog, \u003ca title=\"http://eve-harris.blogspot.com/\" href=\"http://eve-harris.blogspot.com/\" target=\"_blank\">A Healthy Piece of My Mind.\u003c/a>\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Patients often make decisions about their medical treatment while sitting on an exam table in a thin cotton gown. But is this the best way to fully understand your options? Of course, some healthcare decisions are pretty easy. For example, if the treatment being offered is easy to use or has a long history of success with only mild side effects.\r\n\r\nBut overall, health care decisions are becoming more complex. Your doctor may offer more than one alternative. Picking among those alternatives may have as much to do with medical evidence as your own preferences. The process known as shared decision making empowers patients to collaborate with their doctors in choosing a treatment, as opposed to the doctor pointing a patient toward one choice.","status":"publish","parent":0,"modified":1335806889,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":813},"headData":{"title":"Share and Share Alike -- Especially in Medical Decisions | KQED","description":"Patients often make decisions about their medical treatment while sitting on an exam table in a thin cotton gown. But is this the best way to fully understand your options? Of course, some healthcare decisions are pretty easy. For example, if the treatment being offered is easy to use or has a long history of success with only mild side effects.\r\n\r\nBut overall, health care decisions are becoming more complex. Your doctor may offer more than one alternative. Picking among those alternatives may have as much to do with medical evidence as your own preferences. The process known as shared decision making empowers patients to collaborate with their doctors in choosing a treatment, as opposed to the doctor pointing a patient toward one choice.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Share and Share Alike -- Especially in Medical Decisions","datePublished":"2012-04-25T21:24:29.000Z","dateModified":"2012-04-30T17:28:09.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"5390 http://blogs.kqed.org/stateofhealth/?p=5390","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/04/25/shared-decision-making/","disqusTitle":"Share and Share Alike -- Especially in Medical Decisions","path":"/stateofhealth/5390/shared-decision-making","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5398\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatient_Caroline_1_Flickr_04252012.jpg\">\u003cimg class=\"size-medium wp-image-5398\" title=\"(Caroline_1: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatient_Caroline_1_Flickr_04252012-300x200.jpg\" alt=\"(Caroline_1: Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Caroline_1: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Patients often make decisions about their medical treatment while sitting on an exam table in a thin cotton gown. But is this the best way to fully understand your options? Of course, some healthcare decisions are pretty easy. For example, if the treatment being offered is easy to use or has a long history of success with only mild side effects.\u003c/p>\n\u003cp>But overall, health care decisions are becoming more complex. Your doctor may offer more than one alternative. Picking among those alternatives may have as much to do with medical evidence as your own preferences. The process known as \u003ca title=\"http://patients.dartmouth-hitchcock.org/shared_decision_making/about_shared_decision_making.html\" href=\"http://patients.dartmouth-hitchcock.org/shared_decision_making/about_shared_decision_making.html\" target=\"_blank\">\u003cem>shared decision making\u003c/em> \u003c/a>empowers patients to collaborate with their doctors in choosing a treatment, as opposed to the doctor pointing a patient toward one choice.\u003c/p>\n\u003caside class=\"pullquote alignright\">“We have an ethical duty to inform our patients what their options are and get their preferences.”\u003c/aside>\n\u003cp>It all has to do with risks and benefits. In a shared decision process doctors put more effort into explaining trade-offs, and patients must think more deeply about what matters most to them. The relationship of shared decision making to better health is still being studied, but \u003ca title=\"https://www.cahps.ahrq.gov/Quality-Improvement/Improvement-Guide/Browse-Interventions/Communication/Shared-Decision-Making.aspx\" href=\"https://www.cahps.ahrq.gov/Quality-Improvement/Improvement-Guide/Browse-Interventions/Communication/Shared-Decision-Making.aspx\" target=\"_blank\">we know\u003c/a> that patients who are involved in making their own medical decisions often have less anxiety and recover more quickly.\u003c!--more-->\u003c/p>\n\u003cp>Patient advocates embrace this approach and doctors increasingly see the importance of collaboration, too. “We have an ethical duty to inform our patients what their options are and get their preferences,” \u003ca href=\"http://cet.usc.edu/faculty/may.html\" target=\"_blank\">Dr. Win May\u003c/a> told me. May is a professor at USC’s Keck School of Medicine. “Even with surgical interventions,” she said, “one can always ask ‘can we wait?’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Case in point: Marcy Baskin. She’s 60 and two years ago was suffering “excruciating” arthritis pain. But despite the pain, she took several months to decide on surgery to replace her arthritic ankle with a prosthesis.\u003c/p>\n\u003cp>Baskin is a yoga practitioner and former personal trainer who values her active lifestyle. She lives in rural Sonoma County with a horse, some chickens, her husband and close family nearby.\u003c/p>\n\u003cp>She met several times face to face with her surgeon and sent “at least a dozen” emails, she told me. Even after the surgeon answered her emails and told her that 85 percent of patients recover well, Baskin feared a bad outcome. She talked with her husband and sister, because “that’s the nature of my family, we talk about stuff like that.” Now 16 months post-op, she is confident she made the right choice in the right way. “I’m engaged in every other decision in my life, why not with my body?”\u003c/p>\n\u003cp>Best-selling author\u003ca title=\"http://www.jeromegroopman.com/\" href=\"http://www.jeromegroopman.com/\" target=\"_blank\"> Dr. Jerome Groopman \u003c/a>told \u003ca title=\"http://www.npr.org/2011/09/21/140438982/becoming-mindful-of-medical-decision-making\" href=\"http://www.npr.org/2011/09/21/140438982/becoming-mindful-of-medical-decision-making\" target=\"_blank\">Fresh Air’s Terry Gross\u003c/a>, “It's very important for people to understand how the (medical) information applies to them as individuals and then to understand ... their own personal approach to making choices ... so that they're confident that what they chose is right for them.\"\u003c/p>\n\u003cp>Groopman and co-author Dr. Pamela Hartzband explain in their book “\u003cem>\u003ca title=\"http://yourmedicalmind.com/index.html\" href=\"http://yourmedicalmind.com/index.html\" target=\"_blank\">Your Medical Mind\u003c/a>\u003c/em>” how our varied personalities affect our decision making. Some people, for example, need to hear about the experiences of other patients in order to truly understand how the treatment (or lack of treatment) will feel. Patients increasingly are reaching out through social media to others with similar diagnoses, hoping to find information or help \u003cem>. \u003c/em>\u003c/p>\n\u003cp>Even if most patients now want more information, and many want greater involvement in decision making, there is a gap. Dr. May says that underrepresented minority patients and those of lower socioeconomic status ask fewer questions. But she insists there is a way to involve practically any patient. “We know that when people have low self esteem they defer (to the provider) but the provider can encourage them.”\u003c/p>\n\u003cp>A small \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/art.22670/pdf\">2007 study\u003c/a> from UCLA demonstrated a way to reduce one such disparity. African Americans suffering arthritis pain have knee replacement surgery significantly less often than Caucasians. This treatment disparity has been linked to a difference in knowledge and expectations of the surgery. Many more African Americans say they expect pain and decreased mobility to continue after recovery from the operation. In the UCLA study, researchers leveled the playing field by showing an educational video during small group meetings. Afterward, expectation of a poor outcome fell among African Americans. All attendees showed the same understanding about the risk and benefit of knee replacement.\u003c/p>\n\u003cp>Moving patients toward greater responsibility overall for their health will take time. May said “There are cultural issues we need to solve -- that’s what we all aspire to.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area health writer. Check out her blog, \u003ca title=\"http://eve-harris.blogspot.com/\" href=\"http://eve-harris.blogspot.com/\" target=\"_blank\">A Healthy Piece of My Mind.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/5390/shared-decision-making","authors":["8344"],"categories":["stateofhealth_12"],"tags":["stateofhealth_236"],"featImg":"stateofhealth_5398","label":"stateofhealth"},"stateofhealth_4886":{"type":"posts","id":"stateofhealth_4886","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"4886","score":null,"sort":[1334005451000]},"guestAuthors":[],"slug":"talking-about-choices-may-encourage-colon-cancer-screening","title":"Talking About Choices May Encourage Colon Cancer Screening","publishDate":1334005451,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By: Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_4913\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatientPic_FlickrVicLawrence_April92012.jpg\">\u003cimg class=\"size-medium wp-image-4913\" title=\"Doctor greating patient\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatientPic_FlickrVicLawrence_April92012-300x200.jpg\" alt=\"Doctor greating patient\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Patient-doctor discussions about choices in colon cancer screening may encourage more people to follow through. (Vic Lawrence: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Although about 50,000 people in the U.S. \u003ca href=\"http://seer.cancer.gov/statfacts/html/colorect.html\">died from colorectal cancer\u003c/a> (CRC) last year, as many as half of those deaths could have been prevented by routine screening. That’s 25,000 lives that could have been saved using tools that are already widely available.\u003c/p>\n\u003cp>The problem is getting people to undergo screening can be a bit of a challenge. The \"ick\" factor of colonoscopies, concerns about paying for them, and other barriers get in the way of adequate screenings. \u003ca href=\"http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-detection\">Alternatives do exist\u003c/a>, such as the fecal occult blood test (FOBT) – a non-invasive test people can do at home and send into the lab. As reported here in the past, \u003ca href=\"../2012/02/23/avoiding-a-colonoscopy-youre-not-alone/\">new tools are also being developed\u003c/a> that use more advanced science to check for markers of cancer, though these are still gaining traction.\u003c/p>\n\u003cp>But now doctors are looking at the psychology of how they talk to patients to figure out what might get the most people to get on board with screening.\u003c/p>\n\u003cp>In a study published today in the \u003ca title=\"http://archinte.ama-assn.org/\" href=\"http://archinte.ama-assn.org/\" target=\"_blank\">Archives of Internal Medicine\u003c/a>, researchers from three medical schools, including \u003ca title=\"http://www.ucsf.edu/\" href=\"http://www.ucsf.edu/\" target=\"_blank\">UCSF\u003c/a>, focused on just colonoscopies and FOBT. The study was done in San Francisco through the\u003ca title=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/\" href=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/\" target=\"_blank\"> Community Health Network\u003c/a>, and randomized doctors into three study groups: one to recommend only FOBT, one to recommend only colonoscopy, and one to offer patients a choice between the two.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers presumed that recommending just one or the other would send a clear signal and be more effective than giving patients a choice.\u003c/p>\n\u003cp>They were wrong.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>What they found instead was that patients who were recommended to get a colonoscopy only followed through 38 percent of the time. Compare that to patients who got a recommendation for FOBT and got screened 67 percent of the time, or those given a choice between the two -- who underwent screening 69 percent of the time.\u003c/p>\n\u003cp>As the researchers say, “Giving choices through shared decision making can improve adherence by increasing patient engagement and allowing for individual patient preferences.”\u003c/p>\n\u003cp>The finding was surprising because previous studies had suggested that talking to patients about the wide range of available options often led them to do nothing at all. As the study authors put it, “[E]vidence also illustrates that providing options of similar value and characteristics can sometimes have a negative impact on adherence due to people defaulting to inertia, presumably because of confusion or indecision between choices.”\u003c/p>\n\u003cp>Dr. Theodore Levin, who heads up Colon Cancer Screening for Kaiser Permanente in Northern California, wrote a commentary in response to the publication. In his words:\u003c/p>\n\u003cblockquote>\u003cp> “If having too many choices leads to confusion, the study by Inadomi et al. demonstrates that not having enough choice may lead to inaction when the only choice is colonoscopy ... When it comes to CRC screening, providing an option other than colonoscopy for our patients is not overwhelming, but necessary.”\u003c/p>\n\u003cp>“What should physicians recommend when talking with patients about CRC? The psychology literature has noted that too much choice is a problem in current society. Patients may be overwhelmed by the options and feel that no option is perfect and therefore choose to do nothing out of confusion. However, every option for CRC screening has its own unique strengths and limitations. A patient-centered approach would take each patient’s perspective into account when designing a screening strategy.”\u003c/p>\u003c/blockquote>\n\u003cp>The study further looked at differences among groups of people to find barriers to screening. The authors wrote:\u003c/p>\n\u003cblockquote>\u003cp>“Prior studies reported low CRC screening rates among racial/ethnic minorities, especially among Asians, Latinos, and African Americans. While the present study confirms the disparity among African Americans, we observed higher adherence among Asians and Latinos than for whites. Our population had established access to health care, which may have reduced these racial differences.”\u003c/p>\u003c/blockquote>\n\u003cp>The study authors also found that people who did their patient-doctor visits in Spanish, Cantonese, or Mandarin were more likely to get screened than people of the same race/ethnicity who chose to do their visits in English.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And, not surprisingly, patients with insurance (public or private) completed screening more often than those without insurance.\u003c/p>\n\n","blocks":[],"excerpt":"Although about 50,000 people in the U.S. died from colorectal cancer (CRC) last year, as many as half of those deaths could have been prevented by routine screening. That’s 25,000 lives that could have been saved using tools that are already widely available.\r\n\r\nThe problem is getting people to undergo screening can be a bit of a challenge. The \"ick\" factor of colonoscopies, concerns about paying for them, and other barriers get in the way of adequate screenings. Alternatives do exist, such as the fecal occult blood test (FOBT) – a non-invasive test people can do at home and send into the lab. As reported here in the past, new tools are also being developed that use more advanced science to check for markers of cancer, though these are still gaining traction.","status":"publish","parent":0,"modified":1334005545,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":721},"headData":{"title":"Talking About Choices May Encourage Colon Cancer Screening | KQED","description":"Although about 50,000 people in the U.S. died from colorectal cancer (CRC) last year, as many as half of those deaths could have been prevented by routine screening. That’s 25,000 lives that could have been saved using tools that are already widely available.\r\n\r\nThe problem is getting people to undergo screening can be a bit of a challenge. The "ick" factor of colonoscopies, concerns about paying for them, and other barriers get in the way of adequate screenings. Alternatives do exist, such as the fecal occult blood test (FOBT) – a non-invasive test people can do at home and send into the lab. As reported here in the past, new tools are also being developed that use more advanced science to check for markers of cancer, though these are still gaining traction.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Talking About Choices May Encourage Colon Cancer Screening","datePublished":"2012-04-09T21:04:11.000Z","dateModified":"2012-04-09T21:05:45.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"4886 http://blogs.kqed.org/stateofhealth/?p=4886","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/04/09/talking-about-choices-may-encourage-colon-cancer-screening/","disqusTitle":"Talking About Choices May Encourage Colon Cancer Screening","path":"/stateofhealth/4886/talking-about-choices-may-encourage-colon-cancer-screening","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By: Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_4913\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatientPic_FlickrVicLawrence_April92012.jpg\">\u003cimg class=\"size-medium wp-image-4913\" title=\"Doctor greating patient\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/DoctorPatientPic_FlickrVicLawrence_April92012-300x200.jpg\" alt=\"Doctor greating patient\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Patient-doctor discussions about choices in colon cancer screening may encourage more people to follow through. (Vic Lawrence: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Although about 50,000 people in the U.S. \u003ca href=\"http://seer.cancer.gov/statfacts/html/colorect.html\">died from colorectal cancer\u003c/a> (CRC) last year, as many as half of those deaths could have been prevented by routine screening. That’s 25,000 lives that could have been saved using tools that are already widely available.\u003c/p>\n\u003cp>The problem is getting people to undergo screening can be a bit of a challenge. The \"ick\" factor of colonoscopies, concerns about paying for them, and other barriers get in the way of adequate screenings. \u003ca href=\"http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-detection\">Alternatives do exist\u003c/a>, such as the fecal occult blood test (FOBT) – a non-invasive test people can do at home and send into the lab. As reported here in the past, \u003ca href=\"../2012/02/23/avoiding-a-colonoscopy-youre-not-alone/\">new tools are also being developed\u003c/a> that use more advanced science to check for markers of cancer, though these are still gaining traction.\u003c/p>\n\u003cp>But now doctors are looking at the psychology of how they talk to patients to figure out what might get the most people to get on board with screening.\u003c/p>\n\u003cp>In a study published today in the \u003ca title=\"http://archinte.ama-assn.org/\" href=\"http://archinte.ama-assn.org/\" target=\"_blank\">Archives of Internal Medicine\u003c/a>, researchers from three medical schools, including \u003ca title=\"http://www.ucsf.edu/\" href=\"http://www.ucsf.edu/\" target=\"_blank\">UCSF\u003c/a>, focused on just colonoscopies and FOBT. The study was done in San Francisco through the\u003ca title=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/\" href=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/\" target=\"_blank\"> Community Health Network\u003c/a>, and randomized doctors into three study groups: one to recommend only FOBT, one to recommend only colonoscopy, and one to offer patients a choice between the two.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers presumed that recommending just one or the other would send a clear signal and be more effective than giving patients a choice.\u003c/p>\n\u003cp>They were wrong.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>What they found instead was that patients who were recommended to get a colonoscopy only followed through 38 percent of the time. Compare that to patients who got a recommendation for FOBT and got screened 67 percent of the time, or those given a choice between the two -- who underwent screening 69 percent of the time.\u003c/p>\n\u003cp>As the researchers say, “Giving choices through shared decision making can improve adherence by increasing patient engagement and allowing for individual patient preferences.”\u003c/p>\n\u003cp>The finding was surprising because previous studies had suggested that talking to patients about the wide range of available options often led them to do nothing at all. As the study authors put it, “[E]vidence also illustrates that providing options of similar value and characteristics can sometimes have a negative impact on adherence due to people defaulting to inertia, presumably because of confusion or indecision between choices.”\u003c/p>\n\u003cp>Dr. Theodore Levin, who heads up Colon Cancer Screening for Kaiser Permanente in Northern California, wrote a commentary in response to the publication. In his words:\u003c/p>\n\u003cblockquote>\u003cp> “If having too many choices leads to confusion, the study by Inadomi et al. demonstrates that not having enough choice may lead to inaction when the only choice is colonoscopy ... When it comes to CRC screening, providing an option other than colonoscopy for our patients is not overwhelming, but necessary.”\u003c/p>\n\u003cp>“What should physicians recommend when talking with patients about CRC? The psychology literature has noted that too much choice is a problem in current society. Patients may be overwhelmed by the options and feel that no option is perfect and therefore choose to do nothing out of confusion. However, every option for CRC screening has its own unique strengths and limitations. A patient-centered approach would take each patient’s perspective into account when designing a screening strategy.”\u003c/p>\u003c/blockquote>\n\u003cp>The study further looked at differences among groups of people to find barriers to screening. The authors wrote:\u003c/p>\n\u003cblockquote>\u003cp>“Prior studies reported low CRC screening rates among racial/ethnic minorities, especially among Asians, Latinos, and African Americans. While the present study confirms the disparity among African Americans, we observed higher adherence among Asians and Latinos than for whites. Our population had established access to health care, which may have reduced these racial differences.”\u003c/p>\u003c/blockquote>\n\u003cp>The study authors also found that people who did their patient-doctor visits in Spanish, Cantonese, or Mandarin were more likely to get screened than people of the same race/ethnicity who chose to do their visits in English.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And, not surprisingly, patients with insurance (public or private) completed screening more often than those without insurance.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/4886/talking-about-choices-may-encourage-colon-cancer-screening","authors":["8344"],"categories":["stateofhealth_12","stateofhealth_14"],"tags":["stateofhealth_82","stateofhealth_193","stateofhealth_236"],"label":"stateofhealth"},"stateofhealth_4769":{"type":"posts","id":"stateofhealth_4769","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"4769","score":null,"sort":[1333667420000]},"guestAuthors":[],"slug":"please-dont-call-it-rationing","title":"Please, Don't Call It Rationing","publishDate":1333667420,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>New Campaign Urges Doctors to Avoid Unnecessary Tests\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_4778\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MRI_Machine_JustUs3_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-4778\" title=\"MRI_Machine_JustUs3_Flickr\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MRI_Machine_JustUs3_Flickr-300x230.jpg\" alt=\"\" width=\"300\" height=\"230\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Just Us 3: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>To many patients, it may seem unbelievable that their doctors would recommend something that is completely unnecessary. But by \u003ca title=\"http://www.rand.org/pubs/research_briefs/RB4522/index1.html\" href=\"http://www.rand.org/pubs/research_briefs/RB4522/index1.html\" target=\"_blank\">some estimates\u003c/a>, that's exactly what happens a third of the time.\u003c/p>\n\u003cp>Yesterday a broad coalition of medical specialty groups -- including cardiologists and family practitioners -- as well as \u003ca title=\"http://web.consumerreports.org/test/SEM/version5.htm?EXTKEY=SG72CR0&CMP=KNC-CROBRANDG&HBX_OU=50&HBX_PK=consumer_reports\" href=\"http://web.consumerreports.org/test/SEM/version5.htm?EXTKEY=SG72CR0&CMP=KNC-CROBRANDG&HBX_OU=50&HBX_PK=consumer_reports\" target=\"_blank\">Consumer Reports\u003c/a> announced a new campaign, \u003ca title=\"http://choosingwisely.org/\" href=\"http://choosingwisely.org/\" target=\"_blank\">Choosing Wisely\u003c/a>. It's a list of 45 tests and procedures that doctors should do much less often for one simple reason: the items on the list are unlikely to be of benefit to the patient.\u003c/p>\n\u003cp>The idea immediately raised questions of rationing and that's exactly where \u003ca title=\"http://www.kqed.org/a/forum/R201204050900\" href=\"http://www.kqed.org/a/forum/R201204050900\" target=\"_blank\">KQED's Forum\u003c/a> started off this morning in discussing the new campaign. UCSF's \u003ca title=\"http://profiles.ucsf.edu/ProfileDetails.aspx?Person=4577990\" href=\"http://profiles.ucsf.edu/ProfileDetails.aspx?Person=4577990\" target=\"_blank\">Dr. Catherine Lucey\u003c/a>, who helped to spearhead the Choosing Wisely campaign, swatted that misconception away.\u003c/p>\n\u003cp>\"It's not rationing,\" she explained. \"Rationing of health care is when you deny needed care to patients. ... Rationing of health care means patients could get better being given a particular drug of subject to a particular test. This is about tests that in many circumstances do not improve quality of life, do not improve quantity of life and potentially could harm patients.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Among the 45 tests and procedures the campaign says to \"question\" are: annual EKGs for patients at low risk of heart disease; MRIs for back pain; and antibiotics for mild-to-moderate sinusitis. The operative word here is \"question.\" Some callers to Forum worried insurance companies would use this information to deny payment, depriving those who might need the test or procedure of something that would be helpful. But Dr. Lucey explained that this is a campaign that was developed by physicians. She said insurance companies had not been involved in the process at all.\u003c/p>\n\u003cp>\"This is not about denying these tests. This is not saying that these tests don't make a difference for some patients,\" Dr. Lucey said. \"It's saying many times they don't. For instance, nuclear cardiologists said 45 percent of routine screening cardiac procedures, stress tests using nuclear radiology, are done for people who don't benefit from those tests, so why do them?\"\u003c/p>\n\u003cp>It was about this time that Forum welcomed \u003ca title=\"http://www.consumerreports.org/health/health-experts/index.htm\" href=\"http://www.consumerreports.org/health/health-experts/index.htm\" target=\"_blank\">Dr. John Santa\u003c/a> to the program. He's director of the \u003ca title=\"http://www.consumerreports.org/health/home.htm\" href=\"http://www.consumerreports.org/health/home.htm\" target=\"_blank\">Health Ratings Center\u003c/a> of Consumer Reports which partnered with the doctor's groups in developing this campaign. (Note: Consumer Reports is generally not a group I associate with supporting rationing).\u003c/p>\n\u003cp>At the heart of the Choosing Wisely campaign is an acknowledgment that patients and doctors need to share in the \u003ca title=\"http://informedmedicaldecisions.org/\" href=\"http://informedmedicaldecisions.org/\" target=\"_blank\">decision making\u003c/a> about a patient's treatment. If a patient wants a test or treatment that is unlikely to benefit them, the doctor needs to explain that. Conversely, if your doctor recommends something to you, you should ask questions. As Dr. Santa noted, Consumer Reports has 75 years of history telling consumers about virtually every industry, including what products work well and what products don't. Now, they find the same desire for information in health care.\u003c/p>\n\u003cp>\"Our surveys of consumers overwhelmingly say they want to have\u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/12/08/how-much-do-elderly-patients-want-to-know-and-should-doctors-tell-them/\" href=\"http://ww2.kqed.org/stateofhealth/2011/12/08/how-much-do-elderly-patients-want-to-know-and-should-doctors-tell-them/\" target=\"_blank\"> those kinds of conversations\u003c/a>,\" Santa explained. \"They are more and more concerned about cost. They're concerned about safety.\"\u003c/p>\n\u003cp>But this is where I need to digress from \u003cem>Forum\u003c/em> (although I think the entire show is worth a listen; the embedded player is below). I fully support avoiding treatments that are not going to benefit a patient. I also support the concept of shared decision making. The problem is that patients, in general, have so much less knowledge and expertise than doctors.\u003c/p>\n\u003cp>And this brings me to the story of my good friend Saskia van Dijl, someone who is both smart and forceful. She recently developed a severe kidney infection and was hospitalized at a well-respected Bay Area hospital. When I visited her in the middle of her three day stay -- a Saturday -- she looked awful. She was receiving IV antibiotics. And she was concerned. While her doctor had not told her directly, the nurses told her they had found an order for a \"PICC\" line -- a peripherally inserted central catheter. It would be inserted in Saskia's arm, to access a major vein for administration of drugs, like the antibiotics Saskia was receiving.\u003c/p>\n\u003cp>But PICC lines are prone to infection, and Saskia knew that. She wanted to switch to oral antibiotics when she went home. When the doctor came later, Saskia was clear with her doctor. \"I asked point blank,\" she told me. \"'Are you absolutely sure there's not an oral antibiotic that would be as effective?' ... I asked that question three times in three different ways. Lisa, I can't even tell you, I really did not want the PICC line. I felt like it was way too much.\" But the doctor was clear. Saskia got the PICC line -- and had to stay in the hospital another night.\u003c/p>\n\u003cp>The next day, a new doctor was on duty. She took another look and saw a new option, based on Saskia's bacterial culture. There \u003cem>was \u003c/em>an oral antibiotic that could work for her. Saskia asked if the first doctor could have known this, and the answer was 'yes.' Within twenty minutes the PICC line was out, and Saskia went home with oral antibiotics. She has recovered fully.\u003c/p>\n\u003cp>Add the cost of Saskia's PICC line to that one-third of unnecessary health care in this country.\u003c/p>\n\u003cp>I caught up with Dr. Lucey after \u003cem>Forum\u003c/em> and told her Saskia's story. She said when a patient pushes back as strongly as Saskia had, it should prompt the doctor to take a second look at the options. \"Stop, let's re-think this,\" she said. Of course, Saskia could have demanded a second opinion. But by the time the first doctor got back to her, it was Sunday--not a great day for looking for doctors for second opinions. It's also hard to rebut a doctor who is telling you \"this is your only option\" when you're quite sick and lying in a hospital bed.\u003c/p>\n\u003cp>I've watched the discussion back and forth for years. Patients say doctors never explained all the risks. Doctors say, \"Patients walk into my office and demand all these tests.\" The \u003cem>Choosing Wisely\u003c/em> campaign which explicitly acknowledges doctors' role in overtreatment is a step forward. Still, if groups of specialists could come up with 45 tests that are generally unnecessary, one might wonder why they didn't come up with the list a long time ago.\u003c/p>\n\u003cp>Dr. Lucey told \u003cem>Forum\u003c/em> listeners, \"Like any other individuals, sometimes we fall into habits. And this campaign is suggesting we need to critically evaluate those habits.\"\u003c/p>\n\u003cp>Hundreds of billions of dollars could be saved if those habits are changed.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Listen to Forum:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204050900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204050900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n","blocks":[],"excerpt":"To many patients, it may seem unbelievable that their doctors would recommend something that is completely unnecessary. But by some estimates, that's exactly what happens a third of the time.\r\n\r\nYesterday a broad coalition of medical specialty groups -- including cardiologists and family practitioners -- as well as Consumer Reports announced a new campaign, Choosing Wisely. It's a list of 45 tests and procedures that doctors should do much less often for one simple reason: the items on the list are unlikely to be of benefit to the patient.\r\n\r\nThe idea immediately raised questions of rationing and that's exactly where KQED's Forum started off this morning in discussing the new campaign. UCSF's Dr. Catherine Lucey, who helped to spearhead the Choosing Wisely campaign, swatted that misconception away.","status":"publish","parent":0,"modified":1335045440,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":1143},"headData":{"title":"Please, Don't Call It Rationing | KQED","description":"To many patients, it may seem unbelievable that their doctors would recommend something that is completely unnecessary. But by some estimates, that's exactly what happens a third of the time.\r\n\r\nYesterday a broad coalition of medical specialty groups -- including cardiologists and family practitioners -- as well as Consumer Reports announced a new campaign, Choosing Wisely. It's a list of 45 tests and procedures that doctors should do much less often for one simple reason: the items on the list are unlikely to be of benefit to the patient.\r\n\r\nThe idea immediately raised questions of rationing and that's exactly where KQED's Forum started off this morning in discussing the new campaign. UCSF's Dr. Catherine Lucey, who helped to spearhead the Choosing Wisely campaign, swatted that misconception away.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Please, Don't Call It Rationing","datePublished":"2012-04-05T23:10:20.000Z","dateModified":"2012-04-21T21:57:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"4769 http://blogs.kqed.org/stateofhealth/?p=4769","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/04/05/please-dont-call-it-rationing/","disqusTitle":"Please, Don't Call It Rationing","path":"/stateofhealth/4769/please-dont-call-it-rationing","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>New Campaign Urges Doctors to Avoid Unnecessary Tests\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_4778\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MRI_Machine_JustUs3_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-4778\" title=\"MRI_Machine_JustUs3_Flickr\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/MRI_Machine_JustUs3_Flickr-300x230.jpg\" alt=\"\" width=\"300\" height=\"230\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Just Us 3: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>To many patients, it may seem unbelievable that their doctors would recommend something that is completely unnecessary. But by \u003ca title=\"http://www.rand.org/pubs/research_briefs/RB4522/index1.html\" href=\"http://www.rand.org/pubs/research_briefs/RB4522/index1.html\" target=\"_blank\">some estimates\u003c/a>, that's exactly what happens a third of the time.\u003c/p>\n\u003cp>Yesterday a broad coalition of medical specialty groups -- including cardiologists and family practitioners -- as well as \u003ca title=\"http://web.consumerreports.org/test/SEM/version5.htm?EXTKEY=SG72CR0&CMP=KNC-CROBRANDG&HBX_OU=50&HBX_PK=consumer_reports\" href=\"http://web.consumerreports.org/test/SEM/version5.htm?EXTKEY=SG72CR0&CMP=KNC-CROBRANDG&HBX_OU=50&HBX_PK=consumer_reports\" target=\"_blank\">Consumer Reports\u003c/a> announced a new campaign, \u003ca title=\"http://choosingwisely.org/\" href=\"http://choosingwisely.org/\" target=\"_blank\">Choosing Wisely\u003c/a>. It's a list of 45 tests and procedures that doctors should do much less often for one simple reason: the items on the list are unlikely to be of benefit to the patient.\u003c/p>\n\u003cp>The idea immediately raised questions of rationing and that's exactly where \u003ca title=\"http://www.kqed.org/a/forum/R201204050900\" href=\"http://www.kqed.org/a/forum/R201204050900\" target=\"_blank\">KQED's Forum\u003c/a> started off this morning in discussing the new campaign. UCSF's \u003ca title=\"http://profiles.ucsf.edu/ProfileDetails.aspx?Person=4577990\" href=\"http://profiles.ucsf.edu/ProfileDetails.aspx?Person=4577990\" target=\"_blank\">Dr. Catherine Lucey\u003c/a>, who helped to spearhead the Choosing Wisely campaign, swatted that misconception away.\u003c/p>\n\u003cp>\"It's not rationing,\" she explained. \"Rationing of health care is when you deny needed care to patients. ... Rationing of health care means patients could get better being given a particular drug of subject to a particular test. This is about tests that in many circumstances do not improve quality of life, do not improve quantity of life and potentially could harm patients.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Among the 45 tests and procedures the campaign says to \"question\" are: annual EKGs for patients at low risk of heart disease; MRIs for back pain; and antibiotics for mild-to-moderate sinusitis. The operative word here is \"question.\" Some callers to Forum worried insurance companies would use this information to deny payment, depriving those who might need the test or procedure of something that would be helpful. But Dr. Lucey explained that this is a campaign that was developed by physicians. She said insurance companies had not been involved in the process at all.\u003c/p>\n\u003cp>\"This is not about denying these tests. This is not saying that these tests don't make a difference for some patients,\" Dr. Lucey said. \"It's saying many times they don't. For instance, nuclear cardiologists said 45 percent of routine screening cardiac procedures, stress tests using nuclear radiology, are done for people who don't benefit from those tests, so why do them?\"\u003c/p>\n\u003cp>It was about this time that Forum welcomed \u003ca title=\"http://www.consumerreports.org/health/health-experts/index.htm\" href=\"http://www.consumerreports.org/health/health-experts/index.htm\" target=\"_blank\">Dr. John Santa\u003c/a> to the program. He's director of the \u003ca title=\"http://www.consumerreports.org/health/home.htm\" href=\"http://www.consumerreports.org/health/home.htm\" target=\"_blank\">Health Ratings Center\u003c/a> of Consumer Reports which partnered with the doctor's groups in developing this campaign. (Note: Consumer Reports is generally not a group I associate with supporting rationing).\u003c/p>\n\u003cp>At the heart of the Choosing Wisely campaign is an acknowledgment that patients and doctors need to share in the \u003ca title=\"http://informedmedicaldecisions.org/\" href=\"http://informedmedicaldecisions.org/\" target=\"_blank\">decision making\u003c/a> about a patient's treatment. If a patient wants a test or treatment that is unlikely to benefit them, the doctor needs to explain that. Conversely, if your doctor recommends something to you, you should ask questions. As Dr. Santa noted, Consumer Reports has 75 years of history telling consumers about virtually every industry, including what products work well and what products don't. Now, they find the same desire for information in health care.\u003c/p>\n\u003cp>\"Our surveys of consumers overwhelmingly say they want to have\u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/12/08/how-much-do-elderly-patients-want-to-know-and-should-doctors-tell-them/\" href=\"http://ww2.kqed.org/stateofhealth/2011/12/08/how-much-do-elderly-patients-want-to-know-and-should-doctors-tell-them/\" target=\"_blank\"> those kinds of conversations\u003c/a>,\" Santa explained. \"They are more and more concerned about cost. They're concerned about safety.\"\u003c/p>\n\u003cp>But this is where I need to digress from \u003cem>Forum\u003c/em> (although I think the entire show is worth a listen; the embedded player is below). I fully support avoiding treatments that are not going to benefit a patient. I also support the concept of shared decision making. The problem is that patients, in general, have so much less knowledge and expertise than doctors.\u003c/p>\n\u003cp>And this brings me to the story of my good friend Saskia van Dijl, someone who is both smart and forceful. She recently developed a severe kidney infection and was hospitalized at a well-respected Bay Area hospital. When I visited her in the middle of her three day stay -- a Saturday -- she looked awful. She was receiving IV antibiotics. And she was concerned. While her doctor had not told her directly, the nurses told her they had found an order for a \"PICC\" line -- a peripherally inserted central catheter. It would be inserted in Saskia's arm, to access a major vein for administration of drugs, like the antibiotics Saskia was receiving.\u003c/p>\n\u003cp>But PICC lines are prone to infection, and Saskia knew that. She wanted to switch to oral antibiotics when she went home. When the doctor came later, Saskia was clear with her doctor. \"I asked point blank,\" she told me. \"'Are you absolutely sure there's not an oral antibiotic that would be as effective?' ... I asked that question three times in three different ways. Lisa, I can't even tell you, I really did not want the PICC line. I felt like it was way too much.\" But the doctor was clear. Saskia got the PICC line -- and had to stay in the hospital another night.\u003c/p>\n\u003cp>The next day, a new doctor was on duty. She took another look and saw a new option, based on Saskia's bacterial culture. There \u003cem>was \u003c/em>an oral antibiotic that could work for her. Saskia asked if the first doctor could have known this, and the answer was 'yes.' Within twenty minutes the PICC line was out, and Saskia went home with oral antibiotics. She has recovered fully.\u003c/p>\n\u003cp>Add the cost of Saskia's PICC line to that one-third of unnecessary health care in this country.\u003c/p>\n\u003cp>I caught up with Dr. Lucey after \u003cem>Forum\u003c/em> and told her Saskia's story. She said when a patient pushes back as strongly as Saskia had, it should prompt the doctor to take a second look at the options. \"Stop, let's re-think this,\" she said. Of course, Saskia could have demanded a second opinion. But by the time the first doctor got back to her, it was Sunday--not a great day for looking for doctors for second opinions. It's also hard to rebut a doctor who is telling you \"this is your only option\" when you're quite sick and lying in a hospital bed.\u003c/p>\n\u003cp>I've watched the discussion back and forth for years. Patients say doctors never explained all the risks. Doctors say, \"Patients walk into my office and demand all these tests.\" The \u003cem>Choosing Wisely\u003c/em> campaign which explicitly acknowledges doctors' role in overtreatment is a step forward. Still, if groups of specialists could come up with 45 tests that are generally unnecessary, one might wonder why they didn't come up with the list a long time ago.\u003c/p>\n\u003cp>Dr. Lucey told \u003cem>Forum\u003c/em> listeners, \"Like any other individuals, sometimes we fall into habits. And this campaign is suggesting we need to critically evaluate those habits.\"\u003c/p>\n\u003cp>Hundreds of billions of dollars could be saved if those habits are changed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Listen to Forum:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201204050900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201204050900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/4769/please-dont-call-it-rationing","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_235","stateofhealth_236","stateofhealth_86"],"featImg":"stateofhealth_4778","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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