Helping Patients Make the Best Medical Decisions
Dale Collins, MD: TDI's New Director of the Center for Informed Choice
June 15, 2009
A researcher as well as a surgeon, Collins came toDartmouth in 1995 to study Outcomes Researchwith John "Jack" Wennberg, MD, founder of TheCenter for the Evaluative Clinical Sciences, nowknown as TDI. Collins earned her Masters of Sciencewhile practicing at Dartmouth-Hitchcock MedicalCenter. In 1999, she joined the Norris Cotton CancerCenter, as the Medical Director of the Comprehensive Breast Program, an interdisciplinaryclinic that integrates patient education materials withdecision-making aids for women diagnosed withbreast cancer. "It's difficult for patients to absorband integrate information, especially when theyhave just received a serious diagnosis. Patients needgood information to make good decisions, and theyneed time to absorb it." In her recent research, Collinshas proven that giving patients decision-makingtools that take into account a patient's values as wellas possible outcomes helps patients make the bestchoices on a case-by-case basis.
"A clear example of patient preference would be awoman choosing a mastectomy instead of a lumpectomy,"Collins explains. "Clinically, they're the same,but emotionally, they're not. Some women chosebreast reconstruction, others don't. These are importantdecisions that only the patient can make."
"Dartmouth is the only academic center in theworld with a hospital-based clinical and researchcenter for shared decision making," Collins says. Asdirector, she plans to promote research, to educatemedical students and clinicians, and to promote theresults of CIC's research to improve patient care andhealthcare policy.
Collins will be aided by co-director HilaryLlewellyn-Thomas, PhD, Professor in the Department of Community and Family Medicine, whospecializes in designing research projects and teachingresearch techniques to investigators. "While some ofthis research takes place in the laboratory and classroom,"Llewellyn-Thomas explains, "most of it takesplace in the clinical setting. It's great to have a clinicalleader like Dale to lead CIC. She really understandsthe importance of fostering individual-based,patient-sensitive, and rational approaches to decisionmaking. Changing systems and getting new informationand tools to patients require clinical championslike Dale, who are willing to rethink and redesignclinical work flow patterns to accommodate newideas in education, research, and practice."
Collins' work with the Comprehensive BreastCancer Program at the Cancer Center has made her a nationalleader in implementing a shared decision-makingprocess into comprehensive, coordinated patientcare. At CIC, Collins plans to build on that work."We need to do research around what are the rightquestions to ask: what's important for the patient tounderstand? How do we help people integrate theirpersonal values into their decision making? Our goalis to help patients make choices consistent with theirvalues-what's uniquely right for them." In her workas a surgeon, Collins has used Patients' DecisionAids-tools designed to help patients understandtheir disease and their own preference for treatmentbased on their thorough understanding of their corevalues along with the likely outcomes of the differentoptions available.
Several departments at DHMC already haveshared decision making processes in place for a varietyof choices patients face, ranging from decidingto undergo cancer-screening procedures to decisionsabout palliative care. A link from the Spine Center's web-page, for instance, leads to informational videosand DVDs available on loan, web-based decisionaids, and a healthcare decision guide for patientswith low back pain. Properly informed patients andtheir physicians can then decide on the best courseof treatment for a particular problem at a particulartime.
In addition to research, CIC's mission includestranslating results into the clinical setting, andinfluencing policy that will ultimately reward thoseclinicians who provide good information that helpspatients make the medical choices best for them.Collins looks forward to the day when a medical center'suse of a shared decision-making process becomesone of the measures of an institution's quality of care.