The new patient decision aid
Torbay Charts is a new style of online patient decision aid, designed to help patients and health professionals make decisions together about a course of care.
What is ‘shared decision making?’
Shared decision making (SDM) is the process where healthcare professionals (doctors, nurses, physiotherapists etc) and patients choose the most appropriate personalised treatment collaboratively based on a patient's values and expectations.
This requires a two-way sharing of information; the healthcare professional (HCP) should provide the patient with details of the treatment, its benefits, the risks and burdens they have to accept if they go ahead with a particular option. Patients should then share their ideas, expectations, concerns and desired outcomes from their healthcare interventions.
Without this conversation, there is no way patients can choose the most appropriate treatment for them and the HCP cannot accurately advise which route to take.
What are ‘patient decision aids’?
Patient decision aids (PDAs) are information resources that provide unbiased and relevant information on the treatment options available for the patient. This can really improve the SDM process, as PDAs should provide clear, easy-to-follow information that helps patients make a decision.
PDAs traditionally present information in a table or long prose which can often be complex, lengthy and difficult to understand. This can sometimes confuse patients rather than help them.
Several PDAs have been developed but not successfully integrated into day-to-day practices. Whether it’s because users find them uninspiring and confusing, or HCPs think they slow the consultation down, it is an issue that has to be rectified.
How is Torbay Charts different?
Our new PDA solution, Torbay Charts, approaches shared decision making and patient decision aids in a completely new and engaging way by providing information in stages and adaptable formats.
Firstly, the main chart gives a complete overview of the progress of the disease and then maps treatment options according to relevant stages.
The patient or HCP can then click on each treatment to discover specific information that might be relevant for the conversation. This information is shown in two different formats; an easy to understand infographic and a clear but in-depth table. The user can choose to use one or both formats.
The areas covered in the table format are consistent and the same for all treatment options, making it much easier to compare treatments.
The infographic is unique because it not only provides a summary of the usual risks and benefits, it also gives valuable additional information about the burdens and restrictions in various activities of daily living (ADL) including cost.
In time, there will be three ways to present this information; the third is a comprehensive leaflet that can be given to patients to take home. This is currently under development.
Torbay Charts allow patients to compare different treatment options side-by-side through tick boxes on the overview page. This means they can drive the comparison themselves and make a truly informed decision about which treatment is right for them.
How to use the Torbay Charts
Torbay Charts is not intended to replace clinical consultation. Instead, it aims to help HCPs and patients make an appropriate decision together and create a much more focused consultation.
The HCP must carry out a routine history taking, examination and organise any investigations deemed necessary. This will help the HCP make a correct diagnosis and determine the stage of the disease by assessing:
- Level of pain
- Intrusion on activities of daily living
- Maximum walking distance
- Physical changes in affected area(s)
The Torbay Charts are not required until the ‘wrapping up’ of the consultation. This is where the HCP may ask the patient about their expectations and concerns with regards to their illness.
Once the stage of the disease and the patient’s expectations are known, HCPs can use the Torbay Charts to drive a further conversation about relevant treatments that align with specific stages of the disease and explore the most appropriate options in greater detail.
Thanks to the PDA, the decision regarding treatment can be made based on a patient's values, expectations and the level of risk they are comfortable with. This helps ensure that they will choose a treatment that is appropriate for them.
Treatments for the early stages of a disease will always start with self-help and simple methods to alleviate symptoms. In some cases, these need to continue right up to the later stages of the disease. Treatments relevant to the latter stages of the disease are usually riskier and are likely to be expensive. These are typically considered after exhausting simpler treatment methods.
Results of the initial pilot
Torbay Charts was trialed by the physiotherapy department in Torbay and South Devon NHS Foundation Trust. This was used by several physiotherapists without formal training in how to use it.
As the charts were very intuitive, there was no difficulty in adopting this new tool. 107 patients have given feedback regarding its usage.
- Over 93% rated Torbay Charts as ‘good’ or ‘excellent’
- The majority of patients felt that Torbay Charts helped with their shared decision making conversation
- 5% of patients chose not to have surgical intervention as they became aware of other options through Torbay Charts
In addition to this, many of the physiotherapists felt that the Torbay Charts helped them have a more focused consultation.
This new patient decision aid allows excellent user interaction and satisfaction. Those who use Torbay Charts rapidly realise that they are immensely helpful and provide vital support throughout the decision making process.