Approach Encourages People to Balance Individual Desires with Broader Societal Concerns

WASHINGTON, D.C. - Public deliberation—a way to capture in-depth perspectives on controversial issues—effectively provides informed public views on complex health policy issues, such as the role of medical evidence in treatment decisions, according to a randomized controlled trial conducted by the American Institutes for Research (AIR) and published in the May edition of the peer-reviewed journal Social Science & Medicine.

The U.S. health care system’s complexity, coupled with the inherently emotional and personal nature of serious illness or injury, often makes it difficult for policymakers to obtain informed public views to help guide decisions on complicated health care issues. Unlike surveys and focus groups designed to measure the prevalence and range of opinions—or so-called top-of-mind opinions—public deliberation encourages people to become informed about a topic and consider alternative—often competing—perspectives. Public deliberation has three main components:

• Educating participants about an issue, usually through neutral, objective written materials or conversations with experts
• Ensuring balance by considering all sides of an issue
• Encouraging participants to keep broader societal concerns in mind along with their individual points of view

Conducted as part of the Deliberative Methods Demonstration funded by the Agency for Healthcare Research and Quality (AHRQ), the AIR study is among the first large-scale randomized controlled trials of alternative methods of public deliberation and included 1,338 people assigned to take part in one of four deliberative methods or to a reading-materials-only control group.

The participants all considered the same health policy issue: “Should individual patients and/or their doctors be able to make any health decisions no matter what the evidence of medical effectiveness shows, or should society ever specify some boundaries for these decisions?”

Between August and November 2012, AIR convened 76 public deliberation groups in four communities: Chicago; Sacramento, Calif.; Silver Spring, Md.; and Durham, N.C. The communities were selected to ensure a diverse sample in terms of racial, ethnic and socio-demographic background, with special attention to including members of three AHRQ priority populations: Hispanics, African-American women and elderly people.

Compared to the control group, public deliberation increased participants’ knowledge of medical evidence and comparative effectiveness research and shifted their attitudes about the importance of medical evidence in treatment decisions, according to the study.

“There is growing awareness that informing and engaging the public—both as patients and as citizens—is critical to achieving better care and better health,” said AIR Vice President Kristin L. Carman, Ph.D., lead author of the study and executive director of AIR’s Center for Patient & Consumer Engagement.

“The study findings indicate that public deliberation is an effective way for policymakers to both engage citizens in complicated health care issues and potentially to ‘see around the corners’ to better understand and anticipate how public attitudes might change as people learn more about specific issues and discuss them,” Carman said.

The results of a related AIR analysis published in the February Journal of Health Care for the Poor and Underserved underscore the value of public deliberation as an effective way to gather diverse public input, including views of people from differing racial and ethnic backgrounds and education levels. The study found that regardless of race, ethnicity or educational attainment, participants showed similar increases in knowledge following deliberation.

“Educational materials and case studies…specifically designed for lay people, combined with deliberation helped participants with different backgrounds to understand complex and controversial topics in medical evidence and decision-making,” the study states.

Both the Social Science & Medicine study, titled “Effectiveness of Public Deliberation Methods for Gathering Input on Issues in Healthcare: Results from a Randomized Trial,” and the Journal of Health Care for the Poor and Underserved study, titled “Deliberation: Obtaining Informed Input from a Diverse Public,” are available online, along with a fact sheet, Public Deliberation: Bringing Common Sense to Complex Health Policy Issues explaining more about public deliberation and the study findings.

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Established in 1946, with headquarters in Washington, D.C., American Institutes for Research (AIR) is a nonpartisan, not-for-profit organization that conducts behavioral and social science research and delivers technical assistance both domestically and internationally in the areas of health, education, and workforce productivity. For more information, visit www.air.org.

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AIR’s Center for Patient & Consumer Engagement is committed to transforming health care delivery in ways that truly put patients and families at the center of care. Greater engagement of patients and families in direct care decisions, health care organizational design and governance, and public policy is key to achieving better care, better health and lower costs. To learn more about the Center’s conceptual framework for patient and family engagement, visit http://aircpce.org.