Marie-Anne DurandASSOCIATE PROFESSOR
One of the most effective ways to improve health outcomes and increase people’s satisfaction with care is through better communication and more responsive, patient-centered decision making. This model for care—often called shared decision making—has at its core a strong partnership between health care provider and patient. The Dartmouth Institute is at the forefront of patient engagement and shared decision making research, working to develop tools to improve communication between patients and healthcare providers and strategies for integrating shared decision making into healthcare practice at many levels.
Breast Cancer: Helping Women Newly Diagnosed with Breast Cancer Make More Informed Decisions
One in eight women will develop breast cancer. The diagnosis is traumatic and life-altering, and information about treatment options can be overwhelming and confusing, particularly for women of lower socio-economic status (SES) or health literacy. A team of researchers led by Dartmouth Institute Associate Professor Marie-Anne Durand, PhD, MSc, and supported by the Patient-Centered Outcomes Research Institute (PCORI), is conducting a three-year study involving 600 women newly diagnosed with early-stage breast cancer at five large cancer centers. The researchers hope to demonstrate that women who are able to use Option Grid™ decision aids during the course of their care are more meaningfully involved in creating a treatment plan for themselves (with their healthcare providers), and that they have lower anxiety, lower decision regret, higher quality of life, and perceive more coordination and integration of care compared to usual care (which typically doesn’t integrate decision aids). They also aim to demonstrate that the Picture Option Grid™, a decision aid that features simple text and images, can reduce disparities in decision making and treatment choice between women of higher and lower socioeconomic status (SES). Approximately half of the women involved in the study will be of lower SES and all study materials are available in English, Spanish, and Mandarin.
For more information: www.mattersmoststudy.com
Uterine Fibroids: Better Informing Women about Scope and Effectiveness of Treatment Options
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. 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. With support from the Patient-Centered Outcomes Research Institute (PCORI), Dartmouth Institute researchers are launching a pilot project that could help women with uterine fibroids make more informed decisions about treatment options. The team, led by Dartmouth Institute Professor Glyn Elwyn, MD, PhD,
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:
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 whether the process of implementation is sustained or “normalized” to become part of the routine workflow at the five sites.
For more information: www.upfrontproject.org