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Comparative effectiveness of encounter decision aids for early-stage breast cancer across socioeconomic strata
Investigator (PI): Elwyn, Glyn
Past Investigator: Durand, Marie Anne
Performing Organization (PO): (Current): Dartmouth College, Dartmouth Institute for Health Policy and Clinical Practice / (603) 653-0800
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2021
Record Source/Award ID: PCORI/CDR-1511-32975
Funding: Total Award Amount: $2,089,937
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Description of the problem the project seeks to solve: Nearly one in eight women will develop breast cancer. This diagnosis is traumatic and life changing for all women. Breast cancer care, breast cancer treatments, and the effect on women's lives are often worse for women of lower socioeconomic status (SES) and lower health literacy. These women are more likely to experience lower knowledge of breast cancer surgery, higher uptake of mastectomy, decision regret, worse patient-centered health outcomes, and poorer care, compared with women of higher SES. These disparities are differences that are not explained by the patient's preferences, but are due to factors that burden women of low SES (e.g., difficulties accessing and understanding information, poor communication with their doctors, and lack of involvement in treatment decisions). Outcomes we hope to achieve: We aim to understand how best to help women of low SES make high-quality decisions about early-stage breast cancer treatments (i.e., so their choice is informed by adequate knowledge and aligned with their informed values and preferences). We will be comparing two effective decision aids used in the health care visit--an Option Grid and a Picture Option Grid--with usual care, in women of high SES and low SES. We hope that the decision aids help all women, regardless of SES, achieve higher decision quality and a treatment choice that is informed by their knowledge and preferences. In addition, we hope to demonstrate that women who have used the decision aids are meaningfully involved in treatment decisions, have lower anxiety, have lower decision regret, have higher quality of life, and perceive more coordination and integration of care, compared with usual care. We also hope to demonstrate that the Picture Option Grid can reduce disparities in decision making and treatment choice between women of high and low SES. Why this project is important to patients: This project is important to patients because making the wrong treatment decision for early-stage breast cancer will have serious consequences on their life and quality of life. This project is likely to change the way patients, regardless of SES, and clinicians make decisions about breast cancer surgery. Explanation of how patients and other stakeholders will help make the project successful: Patient and stakeholder partners have planned the study with the research team. They have been involved in designing the study, choosing the outcomes to be measured, and formulating the research questions. They will also be involved in conducting the study and monitoring progress and risks. At each site, one patient associate will recruit patients with the research assistant, and they will collect and analyze data. Their continuous input in designing, planning, conducting, and managing the study will maximize the success of recruitment and of the data collection procedures, and the applicability and implementation potential of the findings and intervention(s).
MeSH Terms:
  • Breast Neoplasms /*diagnosis
  • /epidemiology /*therapy
  • Communication
  • Comparative Effectiveness Research
  • Decision Making
  • * Decision Support Techniques
  • Female
  • Health Literacy
  • Humans
  • Multicenter Studies as Topic
  • Outcome Assessment, Health Care
  • Patient Education as Topic /*methods
  • Patient-Centered Care
  • Poverty
  • Professional-Patient Relations
  • Quality of Life
  • Social Class
Country: United States
State: New Hampshire
Zip Code: 03755
UI: 20164029
CTgovId: NCT03136367
Project Status: Completed
Record History: ('2020: PI changed; Project extended to 2021. 2017: Project extended to 2020.',) ('Lay Title: Helping women with breast cancer choose between surgical treatment options',)