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 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)