What matters most: helping patients make the right decisions

With the abundance of messages for prostate cancer awareness throughout “Movember”, some Canadians will adopt a “screen early and screen often” mentality. It makes sense. After all, prostate cancer will represent 10% of all cancer deaths in men in 2012 . But did you know that screening for prostate cancer in healthy, low-risk individuals is controversial? Are you aware of the risks as well as the benefits of the procedure? Does it matter to you?

Distinguished Professor Emerita Annette O’Connor, who recently retired from the School of Nursing at the Faculty of Health Sciences, University of Ottawa, has devoted most of her career to ensuring that people have access to balanced information before making tough health care decisions.

“As a nurse in the late ’60s and early ’70s, I was struck by patients’ lack of access to information and participation in decision making,” recalls Professor O’Connor. “So when I did my PhD, I really wanted to focus on patient engagement in decision making.”

Thirty years ago, she was one of the few researchers to focus on helping patients make better decisions with their health practitioners. Now, “thirty” also represents the number of decision aids developed by Professor O’Connor and her colleagues. These free online tools include up-to-date information on health care issues ranging from arthritis to end-of-life care. They help patients clarify their personal values and guide them in the decision making process.

Professor O’Connor, was awarded the 2012 Career Achievement Award from the Society for Medical Decision Making (SMDM), and as someone who has always taken her time when making decisions, she recognizes the importance of the process. “After one year, you might not remember the details, but you will remember that you went through a good process and made the best decision at that point,” she explains.

Decision aids also help friends and family to better understand a patient’s decision. Consequently, these aids hold great promise as communication tools for health- or family-related decisions. Professor O’Connor has used her Ottawa Personal Decision Guide (OPDG) in family discussions on hot topics such as politics. She recalls her husband and son arguing during a previous election. It was easy to predict who was going to vote for who, but the decision aid helped them see the grey areas. “They had more in common than they thought,” continues O’Connor. “Although they were arguing their opposite point, they did see the value in each other’s perspective.”

According to Professor O’Connor, the big lesson is that things generally don’t tend to be black and white. As such, she hopes to see the generic decision aid integrated into schools for use by young adults. “They would learn how to assess and address their decisional needs such as inadequate information, values clarity, or support,” she asserts.

Even after a distinguished career in decision making, as recognized by the Society for Medical Decision Making and the Canadian Academy of Health Sciences, Professor O’Connor faces her own uncertainties. “It’s still hard for me to make decisions,” admits O’Connor. As a Tier 1 Canada Research Chair and Senior Scientist at the Ottawa Hospital Research Institute, one of those tough decisions was when to retire. But as Professor Emerita, she is excited to see the next generation of researchers and students take over. She is also proud to know that her work has inspired large-scale interventions around the world, including a pilot project involving shared decision making interventions in American Medicare populations under President Obama’s new health care legislation.
______________________
[1] Canadian Cancer Society. (August 22, 2012). Prostate cancer statistics at a glance. Retrieved November 21, 2012, from www.cancer.ca

Text: Mélodie Gagnon, Faculty of Health Sciences
Photo: Mélanie Provencher
Published: December 2012