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Does Shared Decision Making Really Increase Health Costs?

Wed, 06/05/2013 - 10:47am
Dave DeBronkart

In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a range of options to treat a condition, informed patients choose less spending and less invasive treatment.

That’s a good thing.

Unfortunately, the University of Chicago press release for a new study released in JAMA Internal Medicine botches the headline, which has already (at this writing) resulted in thousands of pages parroting, verbatim, something the study doesn’t say. The false headline:

“When doctors and patients share in decisions, hospital costs go up”

The study didn’t even look at what happens when decisions are shared. If press releases had licenses, this one’s should be revoked:

  • The study measured attitudes, not what happens when decisions are shared.
  •  Contrary to the headline, the study did not claim causation; it reported a possible correlation (“may be associated with”). Any student of statistics knows that a correlation doesn’t prove cause and effect; this headline is wrong.
  • It creates an impression – no, it explicitly states – that patient engagement increases cost, contrary to all prior evidence. That is, simply, bad journalism.

Bad timing and misconstrued sequellae

The study was released on a Monday holiday (Memorial Day) – the journal’s usual weekly schedule. By 9 a.m. Tuesday, thousands of sites and media outlets had already posted it, with no critical analysis of the study itself – reporters only saw (and often parroted) the press release. As Health News Review has often reported, that’s sloppy reportage, and it can cause real harm.

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