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Breast Cancer Screening Shared Decision Making Toolkit
Principal Investigator: Beth Burnside/Sarina Schrager
Summary of Study: Based on information gathered from previously funded physician interviews and patient focus groups, our multidisciplinary team has developed an alpha version of the Breast Cancer Risk Estimator (B~CARE) embedded in the EHR at UW (HealthLink). We aim to demonstrate the impact of B~CARE 2.0 for women considering the decision to undergo mammography with their primary care physicians, focusing on the outcomes of decision conflict, patient satisfaction, physician satisfaction, and duration of the clinical encounter. The next crucial step for our team is to codify and measure core components of shared decision making using the RE-AIM framework for measuring implementation success. Lastly, we aim to assess the operational impact of the B~CARE tool within a primary care encounter.
Objective: To improve physician/patient communication for screening mammography decision making.
Eligibility and Exclusion of Recruitment: Eligible women are 40-49, English speaking, have not had a mammogram in 9 months. Exclusion criteria include a history of dementia or breast cancer.
Study Design: Test the effect of B~CARE among women who are making the decision to undergo mammography with their primary care physicians: improving health indicators (projected morbidity & mortality); health related quality of life (false positives, psychological distress, patient satisfaction and information competence) and projected impact on improving disparities in breast cancer screening.
Phase I: A preliminary sample of study participants (physician/patients) will consent/participate in evaluating the B-CARE 2.0 decision tool. This cohort will use the tool in a clinical encounter. We will then survey physician/patients focusing on the outcomes of decision conflict, patient satisfaction, physician satisfaction, and duration of the clinical encounter.
Phase II: With the aid of WREN, we plan to audiotape patient/physician dyads to extract the core components of shared decision making from these interactions in order to demonstrate fidelity. These clinical interactions will be transcribed and then coded for a range of outcomes using WordStat, a text analysis platform for the extraction of themes and trends, along with precise measurement of predefined topic areas. This will allow us to observe how both patients and providers steer the shared decision making discussion, and correlate aspects of these interactions (source of utterance – patient or physician; type of utterance – declarative or interrogative; content of utterance – risks/benefits, expectations, or values).
We will also survey patients and physicians to qualitatively assess possible barriers and facilitators for the RE-AIM metrics that can be predicted based on experience. Specifically, we will identify factors that physicians perceive will determine Reach and Adoption (in order to maximize them in the future) and incorporate these metrics into our evaluation framework.
Phase III. We have submitted an application to the UW Health Innovations Grant Program to operationalize the B~CARE shared decision making tool within a primary care encounter. We propose the development of a process whereby this tool is used during health maintenance exams in an efficient, standardized, and evidence-based manner. We will receive notice to this application in late August.
Study Contact Person: Sarina Schrager, MD (DFMCH)
Date of Approval: September 15, 2016