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Helping Women Make Better Decisions About Their Health

Elissa Ozanne, PhD, is a decision scientist.

We make hundreds of decisions everyday, including what to wear, what to eat for breakfast, when to leave for work. We make these simple decisions intuitively. But when it comes to making decisions about complex health issues it is unwise to rely on intuition alone. Yet when faced with strong messaging about the prevalence of breast cancer, many women continue to rely on intuition when making decisions about their risk.

“Women commonly think they will most likely die of breast cancer, yet this fear is disproportionate to the actual risk women face—more women die of heart disease than breast cancer,” says Ozanne, an associate professor at The Dartmouth Institute for Health Policy and Clinical Practice (TDI).

Decision scientists, such as Ozanne, are helping women to better understand the risks they face, whether perceived or actual, when thinking about breast cancer. “We bring the data together and develop tools that can be used to educate and teach patients, to help women assess their risk, and to facilitate shared decision-making with their physicians about their care,” she says.

Transforming data into practical, real world examples of health risks to illustrate how different treatment choices affect treatment outcomes, provides structure and guidance for patients and physicians as they think through complicated personal and medical questions to determine the best treatment options. While decision aids for clinicians are available for a wide range of health issues, few aids for breast cancer risk reduction have been developed.

“Breast cancer risk reduction has the potential to decrease the incidence of the disease,” Ozanne says.

Primarily creating risk models used in treatment decision aids and in breast cancer prevention, Ozanne and her TDI colleagues have developed a web-based tool that provides automated risk assessment and personalized decision support for collaborative use between patients and clinicians—and it lowers the danger of focusing on a single health issue.

“This tool helps women understand that breast cancer isn’t their number one health concern,” she says. “In some families where breast cancer is a hereditary problem, it should be on their list of things to address, but it shouldn’t be to the exclusion of others.”

The tool estimates an individual patient’s risk of breast cancer when compared to that of an average woman to determine whether they have an increased risk. It also helps women identify interventions that they may or may not want to take on, Ozanne says. “The tool also explains how those interventions are expected to change a patient’s risk profile. High-risk patients can then evaluate whether an intervention to reduce their risk will reduce it enough for them to go forward with that intervention that may have associated side effects.”

We can’t modify a family history of breast cancer, but we can identify modifiable risks identified by decision aids and this is where women need to focus, she adds.

An avid runner, Ozanne is passionate about preventative health care. She says there is a lot we can do for ourselves by proactively improving our health so we aren’t constantly putting out fires. “We should be asking what we can do on an individual basis that will help keep us healthy,” she says.

“Much of my work in building decision aids is in line with my philosophy of bringing the patient into the process and having them become a key player in optimizing their health,” say the advocate for patient-centered care.

Dartmouth values that type of approach, she notes, they are very strong in shared decision-making and have a long history around that. It’s one of the reasons Ozanne left the west coast last year and headed east.

There are huge gains to be made by making the most of the information we have about an individual, she says. Ozanne and her colleagues have identified 10-12 modifiable risk factors in terms of mortality, ranging from not wearing a seat belt to how many nuts you eat.

“I like the diversity and intellectual engagement of my colleagues,” she says. “My work can’t be done in a vacuum. I meet with radiologists, genetic counselors, ob-gyns—the entire spectrum—and bring together all of those different perspectives for the same goal of helping a patient achieve a positive outcome. It’s what I really like about my job.”