Notes & Links: October 7, 2013

Why Are ObamaCare Opponents So Vehement?
David E. Williams posting on HealthWorks Collective gives us perhaps the most rational answer to the above question I have seen. Short and sweet but cuts to the chase in all this insanity of stopping ObamaCare even if we destroy our economy and the global economy. 

Why they feel the way they do

  1. They feel the legislation was rammed down their throats and they were disenfranchised
  2. They honestly feel ObamaCare will be the ruination of the world’s greatest health care system 
  3. They believe ObamaCare will bankrupt the country
  4. The bill is too complicated
  5. They want to appeal ObamaCare and replace it with something better

I buy those. Williams shows why none of those reasons hold water in a clear and on point fashion. But for me the most telling reason is the one he ends with…

A more objective read is that some opponents have whipped themselves into a lather over their revulsion to all things Obama and are living in an echo chamber where these views seem rational. It would be better for everyone if they went back to the Birther madness.

Security Concerns to Be Considered When Downloading Human Immunodeficiencey Virus/Sexually Transmitted Disease Related Smartphone Application
A letter to the editors of JMIR from Brito-Mutunayagam addresses a recent article reviewing Mobile Phone Apps for the care and prevention of HIV and other STDs. The article addressed security concerns. Brito-Mutunayagam says the bigger concern is that if an app is not developed by a a named professional health care body or organization. 

It is a great letter and fits with the current trend of showing data regarding medical apps and the outcomes they deliver. Well worth the read. 

A Web-Based Tool to Support Shared Decision Making for People with a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation
Van der Krineke, Emerencia, et al out of the University of Groningen Leeuwarden, Netherlands published this RCT. There has been a great deal written and studied on shared decision making. Here is a good overview on the topic for some background. 

Methods: The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation.

Conclusions: The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate.

Shared decision making is important and there have been any number of reviews, analysis, and RCT herehere, and here. And here is a great site in Canada using SDM. It is simple in its concept and offers important and critical outcomes for patients. But at times it strikes me that we are making this far more complex and involved. Donna’s oncologist at our first meeting drew a horizontal line on a chart note. On the left side of the line he wrote me on the left side of the line he wrote you (Donna). He said ” Place an X how you want to work together to make decisions regarding your care. On the left I will make all decisions. On the right you make all the decisions.”

This is shared decision making succinctly presented and adhered to. This may not fit all patients but what it does do is open the discussion and create a sense of engagement and empathy which is the foundation for SDM. 

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