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The Foundation for Informed Medical Decision Making of Hanover, NH, has produced a series
of interactive video disks, called Shared Decisionmaking Programs, to help patients reach
decisions about treatment options. When patients have access to outcomes information and
weigh the probable risks and benefits of various treatments, they can make choices they feel are
best for them.
Patients access information in the offices of their providers, first answering the computer's
questions about factors such as their health status, age, and symptom severity by touching the
choices on the screen. In addition, the patient responds to the computer's questions about the
outcomes of any previous treatments for the illness.
After the computer has all the necessary information, it responds by describing alternative
treatment choices, listing the pros and cons of each, and presenting each user's specific
probabilities of experiencing various outcomes.
Of the seven interactive Shared Decisionmaking Programs produced so far, four are based in
part on research funded by AHCPR. The four programs are on BPH (benign prostatic
hyperplasia enlargement of the prostate gland in men), prostate cancer, low back pain, and
ischemic heart disease.
The BPH Shared Decisionmaking Program is being studied or installed at more than 100 health
care provider settings throughout the United States, Canada, and Europe. Among the users are
various Blue Cross/Blue Shield associations, several regional Kaiser Permanente HMOs, and
many different types of health care delivery systems.
According to a February 25, 1992, Wall Street Journal article, prostate surgery rates
among patients of a Kaiser Permanente HMO in Denver dropped 44 percent after interaction
with the Shared Decisionmaking Program on BPH. The article went on to state that at the
Group Health Association of Puget Sound HMO in Seattle, prostate surgery rates fell 60 percent
after use of the interactive video disk program. The HMO is also testing the back pain treatment
interactive video disk.
Men facing BPH treatment decisions can also get information about the benefits and risks of
different therapies through a new patient guide, Treating Your Enlarged Prostate,
published by AHCPR. The booklet was released by AHCPR in
February 1994 with a new clinical practice guideline, Benign Prostatic Hyperplasia:
Diagnosis and Treatment.
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