Current Projects

Here are some of the projects currently underway at the Health Decision Sciences Center and the Informed Medical Decisions Program:

The Orthopedics Implementation Study

Years: 2020 – ongoing

The purpose of the study is to improve the quality of orthopedic surgery decisions by implementing patient decision aids into routine care for hip, knee and spine patients. Studies have shown that shared decision making (SDM), supported by use of patient decision aids, can improve patient knowledge, reduce decision conflict and even improve health outcomes. However, there are few examples implementation of SDM and decision aids in routine care. The goal of this study is to engage a dozen clinics and to work with them to deliver a decision aid to at least 50% of eligible patients before their surgery. There will be three phases of this project: Phase 1: Local Implementation, Phase 2: Learning Collaborative, and Phase 3: Implementation.

Engaging patients in decisions about rescheduling colonoscopies delayed due to COVID-19

Years: 2020 – ongoing

As the initial surge of patients with COVID-19 recedes, one pressing issue facing health care systems is how to manage the large and growing backlog of screening tests and elective procedures. Managing demand with reduced capacity represents a key new challenge for health care delivery systems during this crisis. Many patients may feel differently about the value of seeking healthcare, including cancer screening, until an effective treatment or vaccine for COVID-19 is found. In this PCORI-funded study, we will examine patients’ preferences for rescheduling a screening or colonoscopy that was delayed or postponed due to COVID. Then, we will study whether shared decision making tools and training will increase patients involvement in decisions, increase their intention to follow through with some type of colon cancer screening, and reduce decisional conflict. There are many challenges to resuming healthcare during this crisis, and this study will address important research questions about how to do this in a safe, equitable and patient-centered manner.

Funding from Patient-Centered Outcomes Research Institute (PCORI)

Promoting Informed Decisions about Cancer Screening in Older Adults (PRIMED Study)

Years: 2018 – 2021

This comparative effectiveness study will address an important gap in our understanding of how to support clinicians and older patients (76-85 yrs) in making high quality decisions about whether to continue colorectal cancer screening. This multi-site randomized trial compares two different decision support strategies. The study results will have wide reaching implications for use of shared decision making in many other decisions for older adults, such as continuing mammography or prostate cancer screening and continuing medications for high cholesterol or hypertension.

Funding from Patient-Centered Outcomes Research Institute (PCORI)

Does “Perfected Informed Consent” Improve Trust in the Physician and Reduce Regret Following Orthopedic Surgery?”

Years: 2018-2020

This research project was funded by CRICO, which is the insurance program that insures all of the Harvard medical institutions and their affiliates. At Partners HealthCare, many patients receive patient decision aids prior to hip and knee arthroplasty and surgery for herniated disc and spinal stenosis, but many do not. This situation creates a “natural experiment” we will use to study whether prescription of a patient decision aid prior to these operations increases trust in the surgeon and reduces regret about the decision, which should result in lower malpractice risk.

Funding from CRICO

Validation of a Measure of Trust

Years: 2018 – 2020

The goal of this project is to develop and validate a short measure of trust, which will be used in the CRICO project.

Funding from CRICO

Matching the Right Patient to the Right Treatment: Shared Decision Making for High-Cost Elective Procedures

Years: 2018 – 2020

This is a three-year grant that will examine whether routine measurement of shared decision making (SDM) for elective surgery decisions, with feedback to clinicians and administrators, has the potential to improve the value of care provided to patients. We plan to enroll 1200 patients in this multi-site trial. Patients who have undergone surgery for hip or knee osteoarthritis, spinal stenosis, or herniated disc will be surveyed to assess the rate of informed, patient-centered decisions. The study will examine how the quality of decisions impact value including patient experience, health outcomes, and costs across the system. We will explore how the data and measures may be used to design incentives to promote SDM and increase value across Partners HealthCare and beyond.

Funding from Donaghue Foundation-Greater Value Portfolio

ACP Peace: Promoting Effective & Aligned Communication in the Elderly

Years:  2018 – 2023

The goal of this project is to improve the quality of medical care delivered to older Americans with cancer through complementary interventions: clinical communication skills training (VitalTalk Training) and patient video decision aids (ACP videos). This is a randomized trial being conducted in three large health care systems with 4500 patients over age 65 with advanced cancer. The goal is to increase documentation of advance directives among participants.

Funding from National Institutes of Health (NIH)

Adapting Measures of Decision Quality for Common Medical Conditions

Years:  2018 – 2021

The project will advance our understanding of how to best measure shared decision making (SDM) across a range of common clinical conditions (e.g. prostate cancer screening, depression, low back pain). This study will summarize the existing evidence of the reliability and validity of the SDM Process score and conduct additional studies in new patient populations (e.g. pediatrics) to extend the generalizability of the measure.

Funding from Agency for Healthcare Research and Quality (AHRQ)

Consumer Assessment of Healthcare Providers and Systems (CAHPS V)

Years: 2017 – 2022

The CAHPS surveys are the most widely used patient experience surveys. The main goal of the grant is to develop and evaluate the next generation of CAHPS surveys. Dr. Karen Sepucha and others in the HDSC are working to examine ways to incorporate shared decision making and measurement of decision quality into the CAHPS assessments.

Funding from Agency for Healthcare Research and Quality (AHRQ)

Participation in a Trial Evaluating the Alignment of Treatment Preferences and Repair Type for Veterans with Abdominal Aortic Aneurysm (AAA)

Years: 2017 – 2022

Collaboration on a cluster-randomized trial being conducted in a network of VA Medical Centers to assess patient and surgeon preferences for AAA repair and whether a decision aid helps match treatment to patient preferences. Shared decision making skills training is offered to participating surgeons.

Funding from Veterans Affairs (VA)

What Engagement Looks Like (WELL) Scale

Years: 2018 – 2019

The goal of this study is to determine whether primary care physicians’ rating of patients’ self-management effectiveness for type 2 diabetes correlates with patients’ reports of self-management effectiveness on a three-item Behavior Change Outcome Questionnaire.  This is a validation study taking place at Massachusetts General Hospital.

Funding from Healthwise

Patient-directed Decision Aid Ordering Projects

Several practices have been utilizing a workflow that provides patients with the opportunity to self-order two decision aid programs of interest. An order sheet was developed with a short description of top decision aids.  This order sheet is given to all patients arriving for their annual visit. The front desk staff will give the patient the order sheet to review. The medical assistant will collect the order form during work-up and place the decision aid order in the electronic medical record. Patients have been very interested in ordering programs both for themselves or a family member. We have seen an increase in decision aid orders over the last few years. In June 2018, we had our 50,000 decision aid ordered.

Funding from Massachusetts General Physicians’ Organization and Partners Center for Population Health

The EPIC Roundtrip Project – Qualitative Assessment

The EPIC Roundtrip is the ability for providers to electronically prescribe patient decision aids in Epic, and for patients to electronically send a summary of their knowledge score, preferences and treatment leaning back to their provider. We will conduct up to 20 interviews with patients and providers to evaluate how they interact with the Roundtrip process.

Funding from Healthwise

Enabling a Paradigm Shift: a Preference-tolerant RCT of Personalized vs. Annual Breast Cancer Screening

This is a large randomized trial comparing the effectiveness of annual mammography with personalized screening for breast cancer. The overall study is being run by Dr. Laura Esserman at University of California San Francisco, and Dr. Sepucha is co-leading the patient reported outcomes group to understand patients’ decision making about trial participation, adherence to screening recommendations, and the role of genetic testing on anxiety and regret among participants.

Funding from Patient-Centered Outcomes Research Institute (PCORI)

Measuring Decision Quality for Patients with Coronary Artery Disease

The purpose of the study, led by Drs. Dudley and Lin at the University of California San Francisco is to develop and evaluate a new survey instrument to measure decision quality for coronary revascularization decisions.

Funding from National Heart, Lung, and Blood Institute (NHLBI)