Marie O'Connor has a unique perspective on shared decisionmaking. She is a care consultant for New York-based health care providers under contract with Anthem, helping them with quality improvement and population health efforts. She is also pursuing her doctorate of nursing at Sacred Heart University. Soon after a faculty member suggested shared decisionmaking as a dissertation topic, Anthem scheduled a required July 2015 virtual training on the same subject for all of its care consultants.
"Everything aligned for me with school as well as work," noted O'Conner. She had started her doctoral research shortly before taking part in the Anthem training, which is based on the SHARE Approach curriculum developed by the Agency for Healthcare Research and Quality.
O'Connor had the opportunity to introduce the shared decisionmaking program to fellow nursing students, and plans to roll out shared decisionmaking technical assistance with the providers she works with as an Anthem care consultant.
Coordinating with Providers on Shared Decisionmaking
In her role as an Anthem care consultant, O'Connor reviews data and analytics with providers, and together they set tailored goals for improving both individual care quality and population health. Shared decisionmaking is a core tenet of Anthem's patient-centered care model for quality improvement.
"These are great concepts that, if practiced, could truly change the way care is delivered…for the better."
Based on her research and training, the value of shared decisionmaking soon became apparent to O'Connor. "These are great concepts that, if practiced, could truly change the way care is delivered…for the better," she said.
For providers, O'Connor observed that "change is scary," even if taken in small steps as outlined in the SHARE Approach, like piloting shared decisionmaking for a single diagnosis. Providers are already grappling with substantial change as they adapt to the shifting landscape for reimbursement and incentives.
"Even though studies show that [shared decisionmaking] doesn't increase consultation times, it's still changing the way they provide service. It's really hard," she said. For now, O'Connor continues to seek the practice leadership buy-in needed to roll out shared decisionmaking to her providers in New York.
"Even though studies show that [shared decisionmaking] doesn't increase consultation times, it's still changing the way they provide service. It's really hard…"
Nursing School Integrates Shared Decisionmaking in Curriculum
O'Connor also rolled out shared decisionmaking training as the basis of her dissertation work at Sacred Heart University in Fairfield, Connecticut.
She started by incorporating shared decisionmaking in an 8-week evidence-based medicine course for 22 masters-level nursing students. She crafted 5 video-based modules of the SHARE Approach curriculum that allowed flexibility for viewing by the graduate nursing students within the prescribed 8-week course. Pre- and post-test surveys showed students' knowledge about shared decisionmaking increased with baseline scores of 70% – 80% rising to 90% – 100% at post-test. O'Connor reports that students "absolutely loved" learning about shared decisionmaking.
O'Connor then worked with faculty to post the training videos to a Sacred Heart Web page for broader access. All nursing faculty now assign students to watch and report back on the videos.
Reflecting on her experiences with other participants at a recent SHARE Approach training she attended in Long Island, O'Connor noted, "There was a lot of talk (among participants) about best practices and about training students before they get into their careers. That's what I did for my project at Sacred Heart."
The SHARE Approach is a five-step process for implementing shared decisionmaking, which offers physicians and other health care professionals the training and tools to help patients compare the potential benefit, harm, and risk of various treatment options for their conditions through meaningful dialogue about what matters most to the patient. The five steps are:
About the Educators
Marie O'Connor works as a senior care consultant at Anthem's Empire Blue Cross Blue Shield, serving New York City and Westchester County. Her role in supporting clinicians included identifying high-risk patients, analyzing data reports, and working to improve quality and the patient experience while reducing costs.
After completing her masters of science in nursing in hospital administration/leadership, O'Connor earned a doctoral degree in nursing practice from Sacred Heart University in May 2016. She gained clinical care experience at White Plains Hospital, where she started her career and served as a telemetry nurse, critical care nurse, and nursing supervisor. She later worked at Stamford Hospital as a float nurse, emergency department nurse, and clinical coordinator on a step-down intensive care unit. She has also been involved in private home care services for the past 7 years.