The HDSC is working on many projects relating to measuring decision quality and implementing shared decision making in practice.
1. Decision Quality Survey Instruments
The team is leading efforts to develop Decision Quality Instruments (DQIs) for a range of common medical conditions, such as treatment of knee and hip osteoarthritis, breast cancer, and prostate cancer screening. The DQIs help answer three questions:
(1) Is the patient informed?
(2) Did the patient get the treatment that best matched their goals?
(3) Was the patient meaningfully involved in the decision?
Shared Decision Making (SDM) is an interactive process that allows patients and healthcare clinicians to work together to select the best medical test or treatment for the patient. Patient decision aids (PtDAs) have been studied in 100+ randomized controlled studies and have been shown to inform and engage patients in decisions about their health care.
3. Shared decision making in Breast Cancer
We have been working with over 100 breast cancer organizations to disseminate breast cancer decision aids and evaluate the implementation of decision aids in different settings. There are five decision aids available that cover the major decisions. This initiative is made possible through a joint effort with Health Dialog, Inc and the Informed Medical Decisions Foundation.
4. Current Research Projects
The Health Decision Sciences Center is participating in several specialty projects across departments at Massachusetts General Hospital. Below are the projects that are currently in progress:
Making Orthopedic Referrals Enhanced with technology and education (MORE study)
With funding from the Gordon and Betty Moore Foundation, we have launched a new study Making Orthopedic Referrals Enhanced with technology and education (MORE study). We are examining how patients diagnosed with hip or knee osteoarthritis, herniated disc or spinal stenosis make decisions about their treatment options. We will examine whether higher quality decisions are associated with better health outcomes for these conditions.
We are conducting a before-after research study in which we will evaluate the impact of an enhanced information technology tool on the timely and reliable delivery of patient decision aids, and then track the impact of the implementation and use of decision aids on the quality of decisions, treatment utilization and the quality of care. Specifically, we expect that the intervention will (1) improve decision quality, by increasing the number of patients who are informed and receive treatments that match their goals and preferences, (2) improve patient-reported health outcomes and (3) lower surgical rates.
Managing Expectations Acute Low Back Pain Study (MAPS)
The back pain care redesign team and the shared decision making team are working together to enhance the use of shared decision making around acute low back pain (ALBP) within two urgent care clinics that see a high volume of acute low back pain patients at Massachusetts General Hospital. As part of a one year grant, from the MGH Clinical Innovations Award, this study aims to understand patients’ expectations, health outcomes and use of services when presenting with acute low back pain.
Specifically, this study examines whether:
1. The intervention will improve decision quality, measured by patients having higher knowledge, more realistic expectations, and clear preferences for management.
2. The intervention will improve patients’ confidence in their ability to self manage their ALBP and patient satisfaction with their symptoms after 2 months.
3. The intervention will reduce the number of inappropriate imaging studies and specialty referrals for ALBP without negatively impacting health outcomes