A team of researchers at Dartmouth’s Geisel School of Medicine, led by Glyn Elwyn, MD, PhD, MSc, has received a $2.1 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to develop a shared decision-making process to help women with breast cancer choose between surgical treatment options. In shared decision making, patients and doctors work together to make health choices.
PCORI is an independent, non-profit organization authorized by Congress in 2010 with the mission of funding research that will provide patients, their caregivers, and clinicians with the evidence-based information they need to make better-informed healthcare decisions. To this end, PCORI funds implementation projects to increase awareness and promote the use of PCORI-funded research findings to improve healthcare practices and health outcomes.
The three-year funding award will support the researchers’ goal of engaging breast cancer teams across the U.S. in a “learning collaborative” to determine the best methods for adopting and implementing conversation aids for early-stage breast cancer treatment options. Learning collaboratives are networks that focus on a set of goals, and are empowered to learn from one another, regularly sharing data about their progress.
The work will build on a previous study conducted by the researchers which tested the effectiveness of two conversation aids used during clinic visits with women who were eligible for either breast-conserving surgery (removal of only cancerous and nearby tissue) or mastectomy (removal of the entire breast) to help the patients choose the treatment that worked best for them.
In that study, the researchers randomly assigned surgeons to use: an option grid (a summary table of treatments written in plain language, including frequently asked questions); a picture option grid (a summary of treatments with pictures and plain language text designed for people with limited health literacy); or usual care (which included educational materials and medical guidance about breast cancer and treatments) during their surgical consultation.
Overall, the study team found that compared with usual care, the conversation aids helped patients better understand their treatment options and feel more involved in the decision process.
“Our research, as well as many other studies, support the idea that well-designed conversation aids lead to much more shared decision making, which is highly valued by patients and widely recognized by healthcare professionals as an important aspect of patient care,” says Elwyn, a professor of the Dartmouth Institute for Health Policy and Clinical Practice and principal investigator on the project. “Therefore, it’s appropriate that these conversation aids be made available to women with early-stage breast cancer on a routine basis.”
In their project, the researchers will work to educate and support clinical teams in adopting the option grid conversation aids, examine which strategies work best to increase their use, and create a learning collaborative—the Shared Decision Making Adoption and Implementation Resource Collaborative—to determine how conversation aids can be best integrated across breast surgery practice settings.
To help guide their efforts, the project team will be advised by a senior group of experienced implementation and improvement scientists and will measure their progress by tracking access and usage of the aids as well as patient outcomes through online surveys given to samples of women.
“We’re working with the American Society of Breast Surgeons (ASBS) and a wide range of other stakeholders, including patients, to create a collaborative that can be sustainable,” says Elwyn. “It’s our hope that the ASBS will be willing to adopt the collaborative, should it prove to be effective.”
The Dartmouth Institute for Health Policy and Clinical Practice is a world leader in studying and advancing models for disruptive change in healthcare delivery. The work of Dartmouth Institute faculty and researchers includes developing the concept of shared decision-making between patients and healthcare professionals, creating the model for Accountable Care Organizations (ACOs), and introducing the game-changing concept that more healthcare is not necessarily better care.