Researchers receive $2 million PCORI funding to analyze use of decision aids in breast cancer treatment

The Dartmouth Institute for Health Policy & Clinical PracticeAug 2 2016

A research team at The Dartmouth Institute for Health Policy and Clinical Practice has received a $2 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to conduct a research project that is likely to change the way women and their doctors make decisions about breast cancer surgery. Led by Assistant Professor Marie-Anne Durand, PhD, the project will compare care that incorporates the use of two effective decision aids-- an Option Grid™ and a Picture Option Grid™ -- with usual care received by women newly diagnosed with early-stage breast cancer (stages I to IIIA).

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.

"It's an extremely difficult time in anyone's life," Durand said, "But, we believe that by using new tools like Option Grid decision aids women will be able to get better information, have more productive conversations with their doctors, and ultimately will be better able to choose the surgery and treatment option that's right for them."

The multi-site, three-year study will include 1,000 patients recruited from four large cancer centers. The researchers hope to show that women who are able to use decision aids during the course of their care are more meaningfully involved (with their physicians) in creating a treatment plan for themselves, have lower anxiety, less decision regret, and a higher quality of life than women who receive the usual care (that typically doesn't integrate decision aids).

The research team also will investigate whether the Picture Option Grid can reduce communication and decision making disparities between women of higher and lower SES. (While the Option Grid is a one-page summary of available treatment options and associated trade-offs presented in a tabular format, the Picture Option Grid also includes simple text and images.)

"Women of lower SES choose mastectomy more often than women of higher SES," Durand said. "But the goal of our research is not to lower the rate of mastectomy among those women but to ensure the decisions they're making are of high quality, meaning that they are based on the best information available and aligned with their priorities, wishes and values. We think Picture Option Grids can help do that."

At each research site, a patient associate will work with a researcher assistant to recruit patients and to collect and analyze data.

"Patient and other stakeholder partners have been and will continue to be involved throughout the study," Durand said. "Their input also will be vital when thinking about a secondary aim of our project, which is to develop strategies that promote the dissemination and sustained use of decision aids."