Shared Decision-Making

Our research examines patient, provider, and caregiver perspectives of shared decision-making related to difficult medical decisions. Specifically, we are interested in barriers and facilitators of shared decision-making among vulnerable patient populations.

Shared Decision-Making in Patients with Locally Advanced Rectal Cancer

Patients with locally advanced rectal cancer who achieve a complete response to chemotherapy and radiation face a difficult choice between surgery and a watch-and-wait approach. Surgery carries meaningful risks to quality of life, while watch-and-wait requires ongoing surveillance and carries a risk of local recurrence. Despite the complexity of this decision, there is currently no standardized way to counsel patients on these options, and no dedicated tool to support individualized decision-making. For more information, download the decision aid: Rectal Cancer Diagnosis.

Researchers at Lahey Hospital and Medical Center in collaboration with the REACH Lab have developed a novel patient decision aid to help patients and surgeons navigate this choice together. We are currently conducting a pilot study testing this decision aid in a tertiary care colorectal surgery clinic among patients with locally advanced rectal cancer who are eligible for watch-and-wait. The study aims to evaluate whether the decision aid improves patient knowledge and reduces decisional conflict, assess its feasibility and acceptability in clinical practice, and measure its effect on shared decision-making from both the patient and provider perspective. Findings from this study will lay the groundwork for future multi-institutional trials and ultimately a national randomized controlled trial to establish this decision aid as a standard part of rectal cancer care. For more information, download the decision aid: Surgery versus Watch-and-Wait for Rectal Cancer.

Shared Decision-Making in Older Persons with End-Stage Renal Disease (ESRD)

Our recent studies of older patients receiving dialysis find that many (1) do not recognize dialysis initiation as a choice, (2) are rarely engaged in end-of-life planning including conversations with physicians, (3) lack opportunity to actively in treatment decision-making, and (4) experience regret. Our study and others found that only 10% of patients had discussed end-of-life care with physicians. This pattern of care is partly attributable to lack of shared and informed decision-making.

Successful end-of-life communication between patients, caregivers, and physicians is associated with superior psychosocial outcomes, less intensive treatment, and greater patient satisfaction. Our lab is currently conducting a randomized control trial to assess the effectiveness of the Decision-Aid for Renal Therapy (DART), an interactive web-based decision-aid that can empower patients to select the modality that best suits them. DART is designed to promote shared decision-making between patients, caregivers, and physicians and align patient preferences with treatment received. The purpose of this study is to assess DART’s effectiveness for improving end-of-life planning and shared decision-making among older patients with ESRD.

Current Funded Projects: "Mitigating disparities in shared decision-making and end-of-life care among African-Americans with kidney failure" (National Center for Advancing Translational Sciences, National Institutes of Health, Award Number KL2TR001063)

Social Networks and Treatment Readiness among Young People Who Inject Drugs (PWID)

As part of the growing opioid epidemic, risk of Hepatitis C has increased dramatically for young PWID. Recently, new treatments have become available with few of the undesirable side-effects associated with interferon and ribavirin. However, most insurance policies will not cover these cutting-edge treatments for young PWID, and the acceptability and desirability of treatment in this high-risk population is poorly understood. As part of a larger study (Tufts REACTs, PI: Tom Stopka), we are investigating the role of social networks in promoting self-efficacy and treatment adherence among young PWID. The REACTs study goals are: to identify key factors related to (1) HCV transmission among young PWID, and (2) interest in, acceptance of, and potential adherence to HCV treatment. We are employing qualitative, quantitative, spatial, social network, and phylogenetic methods, as well as computer applications and mobile apps that engage PWID in data collection and help promote and monitor future HCV treatment initiation and adherence.

Current funded projects: "Tufts REACTS: Tufts Responds to the Epidemics of Addiction and Hepatitis C Together" (Tufts Institute of Innovation)