Research at the MGH is interwoven throughout more than 30 departments, centers and units and is conducted with the support and guidance of the MGH Research Institute. The Research Roundup is a monthly series highlighting studies, news and events.
Breast Cancer Screening Research Highlights How Flawed Science Contributes to Health Disparities
Current guidelines for breast cancer screening issued by the U.S. Preventative Services Task Force recommend beginning mammograms at age 50 for women at average risk. However, given these guidelines were based on data primarily gathered from white women, David Chang, PhD, MBA, MPH, researcher in the Department of Surgery, wondered if they were inclusive enough to address racial differences, thus putting other populations at risk.
To investigate, Chang and his team analyzed National Cancer Institute data covering women ages 40 to 75 who were diagnosed with breast cancer from 1973-2010.
They found that nonwhite women – specifically Hispanic, Asian and African-American – tended to be diagnosed with breast cancer in their mid-40s to mid-50s, significantly earlier than white women and often too early to benefit from mammograms begun at age 50.
These results support the development of guidelines calling for earlier initial screening of some nonwhite women and highlight the pitfalls of basing clinical recommendations on data that is heavily skewed towards one race or ethnic group.
Chang and his team will soon start a new course at Harvard Medical School to teach future physicians and physician scientists about culturally sensitive science.
New Study Seeks to Improve Shared Decision Making Among Minority Patients
A new study by a research team led by Margarita Algeria, PhD, chief of the MGH Disparities Research Unit, provides insights into how to empower minority patients and improve their quality of care using shared decision making.
Shared decision making is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans that balance risks and expected outcomes with patient preferences and values.
There have been multiple barriers to large-scale implementation of shared decision making, particularly among patients from racial and ethnic minorities, as is evident from previous work by Alegria that tested a shared decision-making intervention known as DECIDE.
The DECIDE intervention employs a six-step process designed to help patients and clinicians arrive at care decisions by working collaboratively. The results of Alegria’s previous studies found that a patient-focused DECIDE intervention (DECIDE-PA) improved patient activation and self-management in behavioral health care settings, but minority patients were more likely than white patients to express concern that becoming activated threatened their relationships with their clinicians.
Given these findings, Alegria and a team of researchers sought to test if pairing DECIDE-PA with a clinician-focused DECIDE intervention (DECIDE-PC) within a minority patient population would be effective for improving both shared decision making and quality of care.
The team conducted a randomized clinical trial in Massachusetts behavioral health clinics. They found that DECIDE-PC alone significantly increased shared decision making as rated by independent third-party coders who reviewed recordings of the sessions but not as assessed by clinicians or patients. DECIDE-PA alone significantly increased patient-perceived quality of care but not shared decision making. The team found that the more DECIDE-PA training sessions the patients attended, the greater the perceived quality, particularly when their clinicians also received more DECIDE-PC coaching sessions.
This study highlights how even a simple intervention can help to improve communication and quality of care. The research team’s next step is to streamline the training and work to successfully disseminate the interventions to new clinical sites.
Read more articles from the 04/20/18 Hotline issue.