Jeff Belkora, associate professor at the University of California, San Franscisco, shares UCSF Breast Care Center's unique approach to support shared decision making: using student health coaches. This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.

1. www.jeffbelkora.com/evidence
List of references to literature
www.jeffbelkora.com/thanks
Sources of inspiration and support
The Patient Support Corps:
An innovative staffing approach for shared decision making
Jeff Belkora, PhD, Associate Professor
University of California, San Francisco
Shared Decision Making in the Real World: Stories from the Frontline
March 6, 2013
Informed Medical Decisions Foundation
Disclosure /Acknowledgment of current funding sources
University of California, San Francisco
The Dartmouth Institute for Health Policy and Clinical Practice
Informed Medical Decisions Foundation
California Breast Cancer Research Program
Robert Wood Johnson Foundation
Quantum Leap Healthcare Collaborative
The Cancer Support Community

2. Background Student health coaches PSC call to action 2
Information and communication needs of patients
• At diagnosis: “Too much, too little, conflicting information”
• During visit: “I forgot to ask questions that were keeping me awake”
• After the visit: “I can’t recall – it all went in one ear and out the other”
Image courtesy of www.speakingaboutpresenting.com

3. Background Student health coaches PSC call to action 3
2004: Who can deliver
decision and communication aids
in the UCSF Breast Care Center?

4. Background Student health coaches PSC call to action 4
Interns!
2005
2006
2007
2008 2009
2010
2011
2012

5. Background Student health coaches PSC call to action 5
Tasks to support patient needs
Before Visit During Visit After Visit
1. Send decision aids 3. Take Notes 5. Burn CD
2. List questions 4. Make audio-recording 6. Print notes

6. Background Student health coaches PSC call to action 6
Patient reactions
• “This was exactly the material I was looking for all over the web, but
having a hard time finding in a consolidated format that made sense…”
• “It was hugely helpful to have my questions prepared beforehand …
• “The recording and notes were invaluable in filling in the parts of the
conversation that were hard for us to remember…”

7. Background Early Results  Lessons & Next Steps 7
RE-AIM Outcomes (www.re-aim.org)
• Reach:
– DAs: 208 to 1,027 annually for a 5-year total of 3,208.
– CAs: from 142 to 348 annually for a 5-year total of 1,228.
• Effectiveness
– DAs: improvements in knowledge, decisional conflict
– CAs: improvements in self-efficacy, question-asking, recall
• Adoption:
– DAs: 76% review videos, 93% review DAs,
– CAs: 67% accept, 83% review summaries, 56% review recordings
– Clinics: Cooperation, Coordination, Collaboration
• Implementation:
– 63 pre-medical interns performing with high fidelity and satisfaction
• Maintenance/Sustainability
– Need to expand workforce at little to no cost

8. Background Student health coaches PSC call to action 8
How can we expand this program?
From the UCSF Breast Care Center…
…to other UCSF clinics…
...to other UC Medical Centers
… to other clinics around the US and around the world…

9. Background Student health coaches PSC call to action 9
Solution: student and other volunteers?

10. Background Student health coaches PSC call to action 10
Patient Support Corps - Strategic Direction
• Purpose
– Patients are informed and involved in their treatment decisions.
• Vision
– All patients have the support they need to be informed and involved.
• Mission
– Provide students and other volunteers to assist patients .

11. Background Early Results  Lessons & Next Steps 11
Patient Support Corps (PSC) – Preliminary Design
Service
Students Patients
Agreement
Academic PSC
Technical Clinic
Institution
Assistance Coordinator
Academic Affiliation Medical
Liaison Agreement Center Liaison

12. Training: ethics,
“Some of confidentiality,
you qualify” privacy.
1. Students 2. PSC Applicants
3. PSCStaff
4. PSC Students
8. PSC Student helps
patient with info and
communication needs
“Student
5. Clinic Patients support?”
“Yes please”
7. PSC Patients
6. Clinic Staff

13. Background Early Results  Lessons & Next Steps 13
Student benefits map on to AGME competencies
• Patient Care: compassion
• Medical Knowledge: social-behavioral sciences …
• Practice-Based Learning
• Teaming with patients, families, and providers
• Professionalism: respect for patient autonomy
• Systems-Based Practice: effective use of system resources

14. Background Student health coaches PSC call to action 14
Value Proposition for The Patient Support Corps
 Low-cost extension of workforce: admin costs only
 Improved marketing/competitiveness for clinics and colleges
 Benefits for patients and students

15. Background Student health coaches PSC call to action 15
Next Steps
We foresee a three year startup period during which we will:
• recruit early members to the network;
• launch service and product offerings;
• refine our business model
We seek funding and other partners to support this expansion.