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Shared Decision Making

The mission of the Center for Shared Decision Making is to empower patients to be full partners in their care by helping them understand their medical choices and consider them in light of their personal goals, values and what matters most to them. Our services include decision support counseling, advance care planning facilitation, appointment preparation and accompaniment, and provision of patient decision aids.

Patient Support Corps

Patient Support Corps volunteers help patients create a "question list" of their concerns, questions and priorities that is shared with the clinician and serve as note-takers during the consultation.

The Patient Support Corps has deepened my understanding of health care and solidified my determination to dedicating my career to helping others. The PSC has inspired me, humbled me, and it has helped me understand my place in the world. I will carry these experiences with me upon graduating Dartmouth and beyond."

PSC Volunteer

Patient Support Corps

Ann, suffered from severe knee osteoarthritis. She enlisted the help of Patient Support Corps member, Jack O'Leary, to accompany her to appointments. Subsequently, during a six- month follow up visit after her double knee replacement, she shared that she was experiencing continued pain and learned the source of her pain was from her arthritic hip. She had found Jack's assistance so invaluable previously that she enlisted his help as she faced this next challenge. Below are quotes from volunteers and grateful patients about the program.

Please accept my deepest gratitude for all of your support. I know that I made wiser decisions because of your department's suggestions and expertise. The Patient Support Corps is my favorite department at DHMC. With Jack's assistance, I came to realize the great significance of a question list."

Ann

Demand for PSC

The Patient Support Corps is a special option that our patients have when receiving care at D-H, and I have only received very positive feedback from my patients who use PSC."

Provider Comment

Coproduction in health care

Dartmouth-Hitchcock is participating with a worldwide cohort in a "coproduction in health care" project sponsored by the Institute for Healthcare Improvement in Boston, MA. Participating D-H teams include Population Health, Palliative Care, Patient Experience (including patient & family advisors), Shared Decision Making and clinical teams from the Norris Cotton Cancer Center and the Heart and Vascular Center.

Coproduction Project Flowchart

Coproduction or codesign in health care describes a process in which patients, families, staff and clinicians work together to create or improve health care delivery. Using the principles of coproduction, our team explores with patients, families, staff, and clinicians what it means to "be prepared" for the health changes that arise after the diagnosis of advanced heart failure or incurable gastrointestinal cancer. Building upon previous advance care planning work at D-H, we are examining how advance care planning resources (e.g. serious illness conversations and advance care planning discussions and documentation) prepare patients for these changes, and how well patients’ advance care plans match medical care (including end-of-life care) received.

Coproduction team

Some members of the coproduction team: Cindy Reuter, ND, LAc, MPH; Amelia Cullinan, MD; Sue Berg, MS; Max Vergo, MD

However, unlike other forms of research or quality improvement that begin with a pre-formed idea of what's broken and how to fix it, the coproduction process empowers patients, families, staff and clinicians (called partners) to help describe the problem, propose solutions, test interventions and select metrics that matter. A six-step codesign "recipe" guides the participatory process.

Our team is interested in developing a variety of ways to disseminate any "preparedness" best practices we discover. Though our partners will help us codesign the final products, possibilities include patient/family peer support opportunities, clinic "playbooks" to guide advance care conversations, and professional training and mentorship. Our team began work on this project in November 2017. We anticipate completing this pilot in mid- to late 2019.

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