Current Studies and Projects

Development and Validation of a Shared-Decision Making Tool for Initiation of Treatment in Patients with Hepatitis C Infection and Advanced Chronic Kidney Disease 

Dr. Politi received a three-year contract award from Merck pharmaceuticals to develop tailored, patient-centered education materials to facilitate treatment decisions in patients with Hepatitis C infection and advanced chronic kidney disease. Dr. Politi will work with co-investigators Tinging Li, MD, associate professor of medicine, and Kevin Korenblat, MD, professor of medicine, in addition to an external advisory board with other hepatologists, nephrologists and patients. Through this award, the team will create a tailored decision tool for patients with Hepatitis C virus and advanced kidney disease that includes patient education, resources, and a helpful physician discussion guide. This tool will then be tested with patients to test its efficacy, usability, and impact on key patient-centered outcomes. Lastly, the research team will conduct qualitative interviews with stakeholders to understand ways to disseminate the tool into routine clinical practice. 

Supporting Cancer Patients Health Insurance Decisions 

Dr. Politi, the PI, beside co-investigators Aimee James, PhD; Esther Lu, PhD; Kenneth Carson, MD; and Timothy McBride, PhD, received a three-year, $700,000 grant from the American Cancer Society. The grant aims to help cancer patients find a health insurance plan that best meets their health and financial needs. Dr. Politi and colleagues will interview cancer survivors about their experience with medical insurance, the financial burden placed on the patient and family members, and specific needs and priorities when shopping for insurance. Data from the interviews will help modify an existing decision support tool, personalizing it so it captures the unique challenges cancer patients face such as the high cost of medications and the challenges with limited networks. Through a 3-arm randomized trial, the decision support tool will be evaluated compared to a generic tool and usual care. 

Optimizing Decision-Making about Breast Reconstruction after Mastectomy: A Patient-Centered Approach

Dr. Politi along with Terence Myckatyn, MD, professor of surgery, received a 2-year, $400,000 Multi-PI Pre-R01 grant through the Siteman Investment Program. Drs. Politi and Myckatyn hope to develop a clinical decision support tool that will enable physicians and patients to make high-quality breast reconstruction decisions consistent with clinical evidence and patient preferences. They plan to incorporate evidence about the risks and benefits of reconstruction, including personalized risk prediction, to estimate individual risk of complications, in addition to patient education and values clarification in this tool. 

Comparative Effectiveness of Encounter Decision Aids for Early-Stage Breast Cancer across Socioeconomic Strata

Dr. Politi received a subcontract award on a PCORI contract through Dartmouth College and will be working with the primary investigator, Marie-Anne Durand, PhD, and co-investigator, Julie Margenthaler, MD, to examine how to support women of lower socioeconomic status with early-stage breast cancer through their treatment decisions. The research team will provide point-of-care decision aids for these women to help increase their knowledge, decision confidence, and quality of life after a breast cancer diagnosis.

Supporting Decisions About Cancer Clinical Trials in Rural Cancer Centers

This is a pilot project partnering with Southern Illinois University School of Medicine (SIUSM) through the P20 2016 Collaborative Cancer Disparities Research Program addressing rural cancer disparities. Dr. Politi is the principal investigator with Swati Pathak, MD, an oncologist at SIUSM. Their project will expand on previous knowledge of shared decision-making tools developed to support decisions about clinical trial participation, bringing an evidence-based research tool to rural communities. The project will address the unique barriers of rural cancer residents and utilize their feedback to help support rural cancer patients participation in clinical trials.

Supporting Decisions about Health Insurance to Improve Care for the Uninsured

- The goal of this project is to compare previously developed decision support strategies about health insurance options to usual care health insurance materials. We will evaluate these strategies’ impact on individuals’ understanding and ability to compare health insurance plan information. We aim to improve currently uninsured individuals’ decision making about health insurance as they prepare to enroll in the Affordable Care Act marketplace plans. Visit us on Facebook.

- Status: Recruitment Completed

Clinician’s Reactions to Discussions With Parents About Clinical Evidence

Vaccines are frequently cited as one of the greatest successes in the history of public health. However, in recent years parental resistance towards childhood vaccinations has been increasing and vaccine refusal may have dire public health consequences. Engaging patients in vaccine discussions may be one way to address parental resistance in a patient-centered way. In order to develop an intervention to improve interactions and communication between providers and vaccine hesitant parents, it is first important to understand how clinicians think, feel and work with this population. The primary aim of this study is to examine the knowledge, attitudes, beliefs, and behaviors of clinician trainees towards vaccine hesitant parents. We will conduct a randomized experiment comparing clinicians’ responses to vaccine hesitant parents, clinicians’ responses to parents in a situation of clinical equipoise (ear tube placement) and their responses to situations of potential overuse (antibiotics) of interventions.

- Status:  Recruitment Completed

A Mixed Methods Study to Reduce Disparities in Cancer Clinical Trials by Supporting Decisions About Cancer Clinical Trials
- The goal of this project is to address disparities in cancer clinical trials through implementing an evidence-based decision aid that prepares patients for cancer clinical trials participation. We will test the effects of this tool compared to a usual care website about cancer clinical trials in a randomized experiment, examining key patient-centered outcomes.

- Status: Recruitment Completed 

Facilitating Shared Decision Making About Lung Cancer Screening

- Shared decision making and patient decision aids can help people understand the evidence about lung cancer screening and decide whether yearly lung cancer screening is right for them. We have developed a tool to facilitate patients’ choices about yearly lung cancer screening.  

- Learn more about lung cancer screening through this decision tool.

Accuracy of Information about the Intrauterine Device on the Internet
- Intrauterine devices (IUDs) are highly effective methods of contraception, but use remains low in the U.S. Individuals increasingly use the Internet for health information. Our objective was to evaluate the quality of information about intrauterine devices (IUDs) among websites providing contraceptive information to the public. 

A Conference Grant to Implement Comparative Effectiveness Research Into Policy
- The goal of this grant is to host a series of conferences dedicated to promoting and building Patient Centered Outcomes Research (PCOR) infrastructure, disseminating PCOR results, identifying opportunities for implementation and incorporation of PCOR findings into health policy, and PCOR career development. 

Save the Date 2017

Selected Past Studies and Projects

Dr. Politi's Participated in Panel Discussion about Health Decision Making Among Vulnerable Populations.

-This panel discussion involved stakeholders at the patient, provider, researcher and organizational level. Representatives from Washington University School of Medicine, Olin School of Business, The College of Arts and Sciences, Brown School of Social Work, and BJC Healthcare discussed how to "Choose Wisely" and match health care needs to patient outcomes among vulnerable populations, particularly those new to insurance with the passage of the ACA. Watch the panel video

Effective Communication to Improve Decision Making about Health Care Plans
- The goal of this project was to develop and evaluate strategies to maximize understanding and ability to compare health care plan information among currently uninsured individuals who were new to the health care system when the Patient Protection and Affordable Care Act was first implemented.

- Please see the following publications to learn more about this study:
A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured. Medical Decision Making. April 3, 2015 0: 0272989X15578635v1-272989X15578635.
Knowledge of Health Insurance Terminology and Details Among the Uninsured. Medical Care Research and Review. February 2014 vol. 71 no. 1 85-98.

Physicians’ Perceptions of Shared Decision Making Behaviors: A Qualitative Study
- The goal of this project was to explore physicians’ and physician trainees’ perspectives of shared decision making and gather in-depth information about barriers and facilitators to SDM implementation in clinical practice.    

- Please see the following publications to learn more about this study:
Physicians' Perceptions of Shared Decision-Making Behaviours: a qualitative study demonstrating the continued chasm between aspirations and clinical practice. Health Expectations. June 17, 2014 0: 10.1111/hex.12216.
Clinicians’ Perceptions of Digital vs. Paper-Based Decision Support Interventions. Journal of Evaluation in Clinical Practice. April, 2015 vol. 21 no. 1 175-179.

A Conference Grant to Build Shared Decision Making Research and Implementation
- The goal of this grant is to host a conference dedicated to the developing a network of researchers to develop, conduct, and disseminate research about the implementation of shared decision making in routine practice. The conference will serve as the first step toward several future projects, such as a multi-site implementation grant designed to facilitate the adoption of shared decision making in practice and a grant to encourage shared decision making training.

- Please see the following resources to learn more about this project:
Insights from a Conference on Implementing Comparative Effectiveness Research Through Shared Decision Making. Journal of Comparative Effectiveness Research. 2013 vol. 2 no. 1 23-32. PMCID: PMC3575182.

- Slides and Talks available here: 
Comparative Research Effectiveness Center at Washington University in St. Louis

Connecting Rarely/Never Screened Women to Mammography Via Kiosks and Navigators
- The study aims to better understand how to increase the use of mammography among rarely and never screened women in the community. We are partnering with a community organization, the Breakfast Club, Inc, to identify never- and rarely-screened women; connect women to breast cancer survivors for personalized navigation and support; and evaluate the effectiveness, reach and acceptability of the intervention.

- Please see the following publication to learn more about this study:
Barriers to Mammography Among Inadequately Screened Women. Health Education and Behavior. April 10, 2014 vol. 42 no. 1 8-15.