My research focuses on identifying and testing methods to improve the quality of decisions about healthcare. My work is largely devoted to the study of decision aids, which I consider to be an important vehicle for improving our health care decisions. Decision aids have been developed for both healthcare providers and patients. Decision aids for providers are often called Clinical Decision Support Systems, while tools designed to facilitate patient decision making are typically called Patient Decision Aids.
Clinical Decision Support Systems
Clinical Decision Support Systems (CDSS) are information systems, typically included in Electronic Medical Records, that provide doctors with patient-specific recommendations to improve clinical decision making. Some of my previous research has shown that patients feel more negatively about physicians who use CDSS than physicians who rely on unaided clinical judgment. This finding has caused concern because these systems have been shown to be more accurate than human judgment alone. Therefore, patients may be doing a disservice to themselves by avoiding physicians who use these tools. My current work in this area is designed to identify how we might present information about CDSS to patients to increase their acceptance of these tools.
Patient Decision Aids
Patient Decision Aids are tools used to help patients make informed medical decisions. These decision aids can be as simple as an informational pamphlet or as complex as an interactive website. They are most often used for preference-sensitive decisions, or decisions where there is no single objective treatment choice (e.g. one that increases survival). An example of a preference sensitive decision is choosing a treatment for early stage breast cancer. For most women diagnosed with early stage breast cancer, the two surgical treatments (lumpectomy with radiation or mastectomy) have the same chances of survival. The best decision for a single woman will depend upon how she feels about the pros and cons of the two surgeries. Making preference-sensitive decisions can be a burden for patients who need to consider complicated medical and statistical information. Patient decision aids can be used to present this complex information in a more digestible form to patients with a variety of educational backgrounds. Click on this link to view a copy of a breast cancer decision aid used in one of my recent studies.
My recent work in this area has explored whether including stories from other patients helps or harms the decision making process. In a paper recently published in the journal Medical Decision Making, we (myself and Dr. Brian Zikmund-Fisher from the University of Michigan) have argued that they key to understanding the effect of patient stories is to first identify the different types of stories that other patients tell. For example, patients can describe their decision making process, their experience with a treatment or disease, or the outcome of a treatment. Our current research projects look at whether these different types of patient stories have different influences on the decision making process.