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Medicine Grand Rounds - Shared Decision Making in the Practice of Medicine: Helping Patients to Understand Evidence, Trade-offs, and Options

Using lung cancer screening as the platform for her work in shared decision making, Dr. Schapira discusses a new paradigm for cancer screening including recognizing and clearly communicating both the potential benefits and potential harms. Her work on a pilot project to engage patients in shared decision making has revealed important communication factors related to clarification of patients’ values, increasing their knowledge about lung cancer, and promoting understanding of benefits and harms of screening tests. Researchers feel it is important to “share the science” and communicate the evidence about detection and diagnosis of lung cancer through decision aids. Based on its high usability, Dr. Schapira’s goal is to implement this process throughout the VA system resulting in improved decision and patient outcomes.

Activity Details

Start Date: November 30, 2018
End Date: November 30, 2020

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

  • Marilyn M. Schapira, MD, MPH
    Professor of Medicine
    Philadelphia VA Medical Center
    Director of General Internal Medicine
    University of Pennsylvania School of Medicine 

    Marilyn Schapira, MD, MPH is a native of Montreal, Canada, and a graduate of Oberlin College and the University of Michigan School of Medicine and Public Health.  Dr. Schapira completed her residency in Internal Medicine at the University of Michigan, and a General Internal Medicine fellowship at Duke University.  Dr. Schapira has been funded to study health numeracy, risk communication and medical decision making pertaining to cancer screening and treatment.  Her work includes the development and evaluation of patient decision support tools, and she has developed a bilingual health numeracy measure using item response theory (IRT) methods designed for use in the clinical setting.  She is currently funded by a VA HSR&D Merit Award to develop and evaluate value preference assessment and shared decision making strategies for lung cancer screening among veterans.
Learning Outcome

At the conclusion of this activity, participants will be able to discuss the shared decision making framework, explain research methods to assess patient preferences and apply principles of developing and implementing decision aids in practice.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Shared Decision Making in the Practice of Medicine: Helping Patients to Understand Evidence, Trade-offs, and Options (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. Dr. Schapira reported no conflicts of interest. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Takeda. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
23 Registered Users