The gynecologists who wanted to be part of this project were very enthusiastic about using the new SDM tools and sharing them with their patients, especially those versions in Spanish and with images.
Dartmouth Institute Researchers Receive $2.1 Million Award for Project Aimed at Better Informing Women with Uterine Fibroids about Treatment Options
Dartmouth Institute researchers have received a $2.1 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to implement a pilot project that could help women with one of the most common and costly health problems —uterine fibroids—make more informed decisions about treatment options. The team led by Dartmouth Institute Professor Glyn Elwyn, MD, PhD, plans to incorporate new research findings about the comparative effectiveness of treatment options into a comprehensive, multi-component shared decision making (SDM) strategy for women seeking treatment for uterine fibroids at five diverse pilot sites.
Fibroids, noncancerous growths in the uterus, are particularly common in women age 35-45 and can significantly affect a women’s quality of life, causing problems like pelvic pain, heavy periods, painful intercourse, and difficulty becoming pregnant. For pregnant women, fibroids can cause miscarriage, preterm birth, and an increased risk of cesarean birth. There is a wide range of possible treatment options available for women with fibroids which vary significantly in terms of cost, recovery, and impact on fertility, among other factors.
The team will incorporate evidence from an earlier PCORI-supported comparative effectiveness study on which treatments for uterine fibroids have the best results into a multi-component shared decision making strategy at Brigham and Women’s Hospital in Boston; Mayo Clinic in Rochester, Minnesota; Montefiore Medical Center, Bronx, New York; Barnes-Jewish Hospital, St. Louis, Missouri; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
The strategy to be implemented at the five sites includes four components: an assessment of each organization’s readiness for SDM and a tailored strategy to address potential organizational barriers to implementation; online or in-person training of clinical teams; and implementation of a paper-based text or picture version and/or a web-based interactive Option Grid encounter decision aid; and, where possible, integration of the new evidence and the SDM approach into existing clinical practice guidelines. At least five gynecologists at each of the sites will introduce the treatment option tools to patients during the clinical visit.
The team also plans to assess the effectiveness of the implementation project by calculating the percentage of patients who receive SDM intervention and whether the process of implementation is sustained or “normalized” to become part of the routine workflow at the five sites.
“The gynecologists who wanted to be part of this project were very enthusiastic about using the new SDM tools and sharing them with their patients, especially those versions in Spanish and with images,” Elwyn says. “What’s more, given the ethnic and geographic diversity included in the five implementation sites, we’re confident that both clinicians and patients will be representative of broader populations—making it more likely that this work will be an important step in helping women with uterine fibroids receive the treatment that best matches their priorities and individual life circumstances.”
The Dartmouth Institute’s team award has been approved pending completion of a programmatic and budget review by PCORI staff and issuance of a formal award contract.
Associate Professor Louise Davies Advocates for Standardizing Definition of Overdiagnosis
Dartmouth Institute Associate Professor Louise Davies, MD, MS, recently wrote about the need for a standardized definition of overdiagnosis in the Annals of Internal Medicine. Davies and co-authors from the University of Arizona College of Medicine and the Kaiser Permanente Center for Health Research in Portland, Oregon, assert that while the possibility of “too much” healthcare is increasingly being recognized by healthcare organizations, agencies, and professionals, overdiagnosis remains a particularly challenging concept to understand and communicate, in part because it cannot be directly measured. To improve understanding and reporting about the potential harms of overdiagnosis, especially as it relates to cancer screening, Davies and her co-authors advocate for defining overdiagnosis as the “detection of a (histologically confirmed) cancer through screening that would not otherwise have been diagnosed in a person’s lifetime had a screening not been done.”
When it comes to estimating overdiagnosis, they also recommend that, at a minimum, researchers should communicate the study design and estimation approach form which estimates of overdiagnosis were derived. If well-conducted, population-based randomized controlled trials with long follow-up and minimal to no screening in the control groups are available, these trials are preferred over observational or modeling studies. Finally, they state that the risk of overdiagnosis from screening should be communicated using messages that will encourage decisions congruent with patients’ values, risk tolerances, and priorities.