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Can patient aides, comprised of online video content libraries of trusted health information, enhance shared decision making between patients and their doctors, lower costs and increase the quality of healthcare? American payors think they can.

Both ends of the stethoscope

We know very little about the hidden dynamics of doctor-patient relationships. We do know however, that doctors have a moral and legal obligation to inform patients about their medical conditions and explain treatment options, but only patients have the right to decide on their treatment. So, how do patients decide about competing treatment options?

For example, how do women, diagnosed with breast cancer, choose between a mastectomy and a lumpectomy? How do mothers choose between Gardasil and Cervarix for their daughters?

Peter Ubel, a professor at Duke University and author of Critical Decisions, provides some insights into the elusive world of private medical consultations between doctors and their patients. According to Ubel medical consultations are fraught with a multitude of unresolved communication issues because doctors', "moral obligations to inform patients, outstrip their abilities to communicate".

In the US there is mounting concern that doctors are aggressively pushing for more costly invasive procedures, even though they may not be any better or safer than slower and simpler ones. Ubel describes how hidden dynamics in doctor-patient relationships and the dearth of premium, trusted and independent patient aides, prevent patients from making optimal medical decisions. This, he says, increases costs and lowers the quality of care.

Spurious online health information

Doctor-patient relationships are further complicated by the ease that patients can access spurious and misleading online health information. It’s true that they also have access to accredited online medical information such as that provided by WebMD. The difficulty however, is for patients and their carers to judge between legitimate and spurious online medical information.

This is confirmed by research published in 2010 by the US National Institute of Health, which reported that over 75% of all people who search online for health information encounter difficulties in understanding what they find and as a consequence become frustrated and confused.

In December 2012, such difficulties resulted in a UK mother, Sally Roberts, denying her seven year old son Neon radiotherapy to treat his brain tumour. Information she found on the internet convinced her that radiotherapy would do more harm to her son than good. The UK hospital treating Neon disagreed, took legal action and a High Court Judge ruled that Neon should receive radiotherapy.

The increasing importance of video in healthcare

US payors are becoming increasingly confident that online video libraries of premium trusted medical information that assist patients to reach more informed decisions about their health are important in shifting emphasis away from clinicians towards patients and their needs, wishes and preferences.

Large US hospital groups are producing trusted and reliable consumer aids that they are using to create, develop and manage specific online patient communities. One example is the Cleveland Clinic, which employs online videos to share health tips and clinical research with patients.
Why video?
One reason video has become so popular among patients is because it delivers a human-touch to health information that digitalized written words don’t. So it’s not surprising that video is the preferred format for patients to receive health information, which increasingly they access on smartphones.

American initiatives
The main push for patient aides to inform shared decision making is from the US Government and health payors and is driven by their efforts to control escalating healthcare costs while improving the quality of care.

For the past six years the state of Massachusetts has produced videos to help terminally ill patients and their carers better understand end-of-life decisions. Washington State, among others, provides patients with video aides to support shared decision making. And three patient aide projects sponsored by the Center for Medicare & Medicaid Innovation are expected to yield savings of more than US$130 million within three years, while enhancing the quality of healthcare.

According to James Weinstein, CEO and President of the Dartmouth-Hitchcock Health System, comprised of 16 medical centres that treat millions, “Patients want to have good information about their health care decisions, which is independent of any bias.”

Jack Daniel, Executive Vice-President of Med-Expert International, a Californian based company, which produces patient aides for people on Medicare and Medicaid said, “When a person calls us we can say here’s what the world’s best medical minds are saying about your condition.”

Takeaways
In 2010 business leaders participating in the prestigious Salzburg Global Seminar concluded that, “Informing and involving patients in decisions about their medical care is the greatest untapped resource in healthcare." Shared decision making they said, “is ethically right and practical, since it lowers costs and reduces unwarranted practice variations”.

Over the past 30 years patients have become better educated and better informed about their healthcare options. Everything suggests that this is just the beginning. Over the next decade, healthcare systems will be increasingly challenged by aging populations, escalating incidences of chronic diseases and fiscal constraints and consumers and communications will assume a more pivotal role. This will accelerate the need for premium, trusted, online health information that patients can access at speed, anytime, anywhere and anyhow.

Until patient aides become commonplace we will not change the way we communicate inside hospitals and doctors’ surgeries. Health costs will continue to rise, the provision of healthcare will continue to be stretched and the quality of care will continue to be challenged.