Cost talk: A randomized stepped wedge trial of interventions helping patients discuss cancer care costs with clinicians during shared decision making

Dr. Politi and co-investigator Glyn Elwyn, MD, PhD, MSc (The Dartmouth Institute for Health Policy and Clinical Practice) received a grant from the Robert Wood Johnson Foundation to investigate whether an encounter decision aid (used during a consultation) containing cost information about localized prostate cancer treatment options, combined with clinician training about cost discussions and available financial resources, influence urologic surgeon-patient cost conversations, referrals to address costs, patients’ FT, and high-quality decision-making.

Implementing a Breast Reconstruction Decision Support Tool in Diverse Practice Settings

Dr. Politi and co-investigators Drs. Terence Myckatyn, Margaret Olsen, Randi Foraker, along with co-PI from Ohio State University Dr. Clara Lee, received a grant (R18HS026699) from the Agency for Health Care Research and Quality to implement a previously developed breast reconstruction decision tool (BREASTChoice) into routine care across diverse clinical practices.

Implementing a Patient-Centered Intervention to Reduce Cancer Patients’ Financial Toxicity

Dr. Politi and co-investigators Dr. Abigail Barker, and Lindsay Kuroki received a grant to adapt, implement, and test the effectiveness of an intervention to reduce the financial toxicity associated with cancer care among patients with breast, colorectal and/or lung cancer. This project is associated with a larger program project (Washington University Implementation Science Center for Cancer Control (WU-ISCCC)) that aims to eliminate cancer disparities in rural and other underserved communities.

Supporting Cancer Patients Health Insurance Decisions
Dr. Politi and co-investigators Drs. Aimee James, Esther Lu, Lindsay Kuroki, Abigail Barker and Timothy McBride received a grant from the American Cancer Society to help cancer patients and survivors choose health insurance plans that best meet their health and financial needs. A decision support is tailored based on patients’ unique health needs and preferences, and the tool was evaluated with a 3-arm randomized trial. Read more about the formative work to develop this tool in a Medical Care Research and Review publication.

Comparative Effectiveness of Encounter Decision Aids for Early-Stage Breast Cancer across Socioeconomic Strata
Dr. Marie-Anne Durand at Dartmouth College and co-investigators Drs. Politi and Margenthaler received a PCORI award to support women of low socioeconomic status through early-stage breast cancer treatment decisions by providing patients with point-of-care decision aids. Read more about the study protocol in a BMC Public Health publication.

Selected Past Studies and Projects

Optimizing Decision-Making about Breast Reconstruction after Mastectomy: A Patient-Centered Approach
Dr. Politi and Dr. Terence Myckatyn received a Pre-R01 grant through the Siteman Investment Program, with co-investigators Drs. Margaret Olsen and Rajiv Parikh, to develop a preference-sensitive decision support tool for patients considering breast reconstruction after mastectomy. The tool provides patient education, elicit patients’ preferences, and include personalized risk prediction to aid in the decision making process. Read more about this project in an Annals of Surgery publication. Read about the formative work in a Plastic and Reconstructive Surgery: Global Open publication and a Health Equity publication.

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 and co-investigators Drs. Tinging Li and Kevin Korenblat received an award to develop a patient-centered decision tool for patients with Hepatitis C virus and advanced kidney disease. The tool (available here) includes patient education, values clarification, and a physician discussion guide to support decisions about treatment for Hepatitis C and chronic kidney disease. Read more about this project in a Kidney Medicine publication.

Supporting Decisions About Cancer Clinical Trials in Rural Cancer Centers
Dr. Politi and Dr. Swati Pathak received an award through the Collaborative Cancer Disparities Research Program for a pilot partnership between Washington University and Southern Illinois University School of Medicine. The project will bring evidence-based decision tools to rural communities and attempt to support rural cancer patients’ participation in clinical trials. Read some findings from the study in the Journal of Cancer Education.

Supporting Decisions about Health Insurance to Improve Care for the Uninsured
This project evaluated the impact of health insurance decision support tools on decision making for uninsured individuals as they prepared to enroll in the Affordable Care Act marketplace plans. Read some findings from the study in BMC Health Services Research or Medical Decision Making Policy and Practice.

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. Our objective was to evaluate the quality of information about IUDs among websites providing contraceptive information to the public. Read more about this project in an American Journal of Obstetrics and Gynecology publication.

Facilitating Shared Decision Making About Lung Cancer Screening
This project developed a decision tool to help patients understand the evidence about lung cancer screening and facilitate patients’ choices about whether yearly screening is right for them.

Clinician’s Reactions to Discussions With Parents About Clinical Evidence
This study examined how clinician trainees think, feel, and work with vaccine-hesitant parents to develop an intervention to improve patient-provider interactions. A randomized experiment compared clinicians’ responses to vaccine-hesitant parents with their responses to parents in situations of clinical equipoise or potential overuse of interventions. Learn more about this project in a 2017 Patient and Education Counseling publication.

A Mixed Methods Study to Reduce Disparities in Cancer Clinical Trials by Supporting Decisions About Cancer Clinical Trials
This project aimed to address disparities in cancer clinical trial participation through the implementation of a decision aid. The tool was tested against a usual care website to examine patient-centered outcomes. Read more in The Oncologist publication.

Dr. Politi’s Participated in Panel Discussion about Health Decision Making Among Vulnerable Populations
Stakeholders at various levels discussed how to match health care needs to patient outcomes in vulnerable populations, particularly those new to insurance with the passage of the Affordable Care Act. Watch the panel video.

Effective Communication to Improve Decision Making about Health Care Plans
This project developed and evaluated strategies to maximize understanding of health insurance and plan information among uninsured individuals who were new to the health care system when the Affordable Care Act was implemented.
-Publications from this study are highlighted below.
A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured. Medical Decision Making. 2016 Oct;36(7):911-22. doi: 10.1177/0272989X15578635. Epub 2015 Apr 3.
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
This project explored physicians’ and physician trainees’ perspectives of shared decision making and gathered information about barriers and facilitators to SDM implementation in clinical practice.
-Publications from this study are highlighted below.
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 was to host a conference dedicated to developing a network of researchers to conduct and disseminate research about the implementation of shared decision making as a first step to future projects and training initiatives. Read more about this project in a Journal of Comparative Effectiveness Research publication. Slides and Talks available through the Patient Centered Outcomes Research Center at Washington University in St. Louis.

Connecting Rarely/Never Screened Women to Mammography Via Kiosks and Navigators
The study examined how to increase the use of mammography among rarely and never screened women in the community. We partnered with a community organization, the Breakfast Club, Inc, to identify never- and rarely-screened women, connect them to breast cancer survivors for personalized navigation and support, and evaluate the impact of the intervention. Read more about this project in a Health Education and Behavior publication.