Past projects from HDSC faculty and staff in the following areas:
Promoting Informed Decisions about Cancer Screening in Older Adults (PRIMED Study)
Years: 2018 – 2022
This comparative effectiveness study addressed 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 compared 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 the Patient-Centered Outcomes Research Institute (PCORI)
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 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 was offered to participating surgeons.
Funding from the Veterans Affairs (VA)
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 was to develop and evaluate the next generation of CAHPS surveys. Dr. Karen Sepucha and others in the HDSC are continually working to examine ways to incorporate shared decision making and measurement of decision quality into the CAHPS assessments.
Funding from the Agency for Healthcare Research and Quality (AHRQ)
Engaging patients in decisions about rescheduling colonoscopies delayed due to COVID-19
Years: 2020 – 2021
Given the COVID-19 pandemic, one pressing issue facing health care systems was how to manage the large and growing backlog of screening tests and elective procedures. Managing demand with reduced capacity represented a key new challenge for health care delivery systems during the crisis. Many patients felt differently about the value of seeking healthcare, including cancer screening, during the COVID-19 pandemic. In this PCORI-funded study, we examined patients’ preferences for rescheduling a screening or colonoscopy that was delayed or postponed due to COVID. Then, we studied whether shared decision making tools and training increased patients involvement in decisions, increased their intention to follow through with some type of colon cancer screening, and reduced decisional conflict. There were many challenges to resuming healthcare during this crisis, and this study addressed important research questions about how to do this in a safe, equitable and patient-centered manner.
Funding from the Patient-Centered Outcomes Research Institute (PCORI)
The EPIC Roundtrip Project – Qualitative Assessment
Years: 2020-2021
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
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 summarized the existing evidence of the reliability and validity of the SDM Process score and conducted additional studies in new patient populations (e.g. pediatrics) to extend the generalizability of the measure.
Funding from the Agency for Healthcare Research and Quality (AHRQ)
Matching the Right Patient to the Right Treatment: Shared Decision Making for High-Cost Elective Procedures
Years: 2018 – 2020
In this multi-site trial, we examined whether routine measurement of shared decision making (SDM) for elective surgery decisions, with feedback to clinicians and administrators, had the potential to improve the value of care provided to patients. Patients who had undergone elective surgery for hip or knee osteoarthritis, spinal stenosis, or herniated disc were surveyed to assess the rate of informed, patient-centered decisions. The study also examined how the quality of decisions impact value including patient experience, health outcomes, and costs across the system. Findings support exploration of how the data and measures may be used to design incentives to promote SDM and increase value.
Funding from the Donaghue Foundation-Greater Value Portfolio
Implementation and Evaluation of a Certified Patient Decision Aid for Women Considering Birth Options After a Prior Cesarean
Years: 2018-2019
A pilot research study conducted at the University of North Carolina Obstetrics practices evaluated the implementation, utilization, and acceptability of a certified patient decision aid on birth options after a prior cesarean. Data was collected on knowledge, decision process, patient preferences, patient satisfaction and clinical processes.
Funding from Healthwise
Effect of Decision Aids on Decision Making for the Treatment of Common Urogynecology Conditions
Years: 2019
This study aimed to determine the feasibility and efficacy of decision aids (DAs) in the field of Urogynecology. More specifically, the goal was to determine if DA’s can increase patient knowledge regarding their diagnosed condition, increase patient confidence in their treatment decisions, and fit into the workflow of a Urogynecology clinic.
Comparative Effectiveness of Decision Aids for Hip and Knee Osteoarthritis: DECIDE-OA
Years: 2016-2018
This PCORI funded, multi-site study, was a three-year grant. Patients visiting a participating orthopedic surgeon for hip or knee osteoarthritis were randomly assigned to receive one of two different decision aids. Surgeons were also randomized to receive a short report about their patients’ goals and treatment preferences or not. The goal was to learn more about how the decision aid format can influence decision making and health outcomes. Furthermore, we were eager to explore if formally delivering patient preferences to surgeons helps improve the accuracy of preference diagnosis. The short summary can be found here.
Funding from Patient-Centered Outcomes Research Institute (PCORI)
Use of Electronic Messaging to Integrate Screening and Online Coaching for Unhealthy Alcohol Use
Years: 2017-2018
This research study conducted at the University of North Carolina-Chapel Hill, evaluated the effect of decision support material on unhealthy alcohol use. The decision support program was delivered electronically via a secure Epic patient portal, and the patient’s response to the decision support program was returned electronically to the patient’s medical record.
Funding from Healthwise
Evaluation of a Patient Decision Aid on Liability Protection
We conducted a series of focus groups to evaluate the decisions of potential jurors in scenarios where a patient had an adverse obstetric outcome, and to test if the use of a decision aid when choosing between a trial of labor or a repeat cesarean after a prior cesarean, reduces medical liability exposure.
Funding from Healthwise
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
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 the National Heart, Lung, and Blood Institute (NHLBI)
What Engagement Looks Like (WELL) Scale
Years: 2018 – 2019
The goal of the study was 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 was a validation study taking place at Massachusetts General Hospital.
Funding from Healthwise
Making Orthopedic Referrals Enhanced with Technology and Education study (MORE)
Years: 2013-2016
The decision to have treatment for hip and knee osteoarthritis, spinal stenosis, or herniated disc is dependent on many factors. In 2013, the HDSC was awarded a grant from the Gordon and Betty Moore Foundation to understand how patients make treatment decisions for these four conditions. Through this grant, we were able to successfully determine how we can reliably integrate decisions into routine orthopedic care to promote shared decision making. This study evaluated the impact of the care redesign initiatives by examining the quality of the decision-making process for patients considering surgical and non-surgical treatment options.
Funding from The Gordon and Betty Moore Foundation
Shared Decision Making in Common Chronic Conditions: Impact of a Resident Training Workshop
Years: 2014-2015
With funding from the Picker Institute and the Arnold P. Gold Foundation, the SDM team developed and delivered a workshop, during a regularly scheduled ambulatory curriculum rotation, to introduce internal medicine residents to shared decision making concepts, give them practice in shared decision making skills, and demonstrate the use of a simple tool to facilitate shared decision making in common clinical encounters. One hundred thirty internal medicine and medicine-pediatrics residents attended 8 workshops over a 4-month period. The training workshop for internal medicine residents was rated highly by attendees and the majority stated they would change their practice based on what they learned.
Funding from The Gold Foundation
Managing Expectations for Acute Low Back Pain Study (MAPS)
Years: 2013-2014
Making decisions about treatment of acute low back pain (ALBP) can be challenging for both clinicians and patients. In 2013, the HDSC and the MGH back pain care redesign team received a Clinical Innovation Award to examine shared decision making in the management of ALBP with three urgent care clinics. Practice guidelines were developed to support physicians in the treatment of back pain; however, patients also need to be informed about what ALBP is and what treatment options are available. This project evaluated the integration of an acute low back pain patient decision aid in urgent care settings at MGH.
Funding from MGH Clinical Innovation Award
Depression and Diabetes Mental Health Initiative
The Alice Rosenwald Mental Health Integration Initiative funded the Mental Health Initiative (MHI) project from January 2015 – December 2016. This project was based in the Internal Medicine Associates (IMA), an adult primary care practice located within the main campus of MGH. The goal of the MHI project was to build on an existing Depression Care (“D-Care”) Initiative at MGH to enhance screening for depression in patients and to improve collaborative management of depression care between primary care teams and behavioral health experts. The MHI program focused on diabetic patients, as studies have shown this population has high rates of depression. The MHI team provided training to medical staff at all levels (including medical assistants and registered nurses). These sessions covered skills such as health coaching, motivational interviewing, shared decision making, and training in behavioral activation for depression care.
Funding from Alice Rosenwald Mental Health Integration Initiative