Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2016

Open Access 01-12-2016 | Research article

Assessing the acceptability and feasibility of encounter decision aids for early stage breast cancer targeted at underserved patients

Authors: Shama Alam, Glyn Elwyn, Sanja Percac-Lima, Stuart Grande, Marie-Anne Durand

Published in: BMC Medical Informatics and Decision Making | Issue 1/2016

Login to get access

Abstract

Background

Women of low socioeconomic status (SES) diagnosed with early stage breast cancer are less likely to be involved in treatment decisions. They tend to report higher decisional regret and poorer communication. Evidence suggests that well-designed encounter decision aids (DAs) could improve outcomes and potentially reduce healthcare disparities. Our goal was to evaluate the acceptability and feasibility of encounter decision aids (Option Grid, Comic Option Grid, and Picture Option Grid) adapted for a low-SES and low-literacy population.

Methods

We used a multi-phase, mixed-methods approach. In phase 1, we conducted a focus group with rural community stakeholders. In phase 2, we developed and administered a web-based questionnaire with patients of low and high SES. In phase 3, we interviewed patients of low SES and relevant healthcare professionals.

Results

Data from phase 1 (n = 5) highlighted the importance of addressing treatment costs for patients. Data from phase 2 (n = 268) and phase 3 (n = 15) indicated that using both visual displays and numbers are helpful for understanding statistical information. Data from all three phases suggested that using plain language and simple images (Picture Option Grid) was most acceptable and feasible. The Comic Option Grid was deemed least acceptable.

Conclusion

Option Grid and Picture Option Grid appeared acceptable and feasible in facilitating patient involvement and improving perceived understanding among patients of high and low SES. Picture Option Grid was considered most acceptable, accessible and feasible in the clinic visit. However, given the small sample sizes used, those findings need to be interpreted with caution. Further research is needed to determine the impact of pictorial and text-based encounter decision aids in underserved patients and across socioeconomic strata.
Literature
1.
Lautner M, Lin H, Shen Y, Parker C, Kuerer H, Shaitelman S, Babiera G, Bedrosian I. Disparities in the Use of Breast-Conserving Therapy Among Patients With Early-Stage Breast Cancer. JAMA Surg. 2015;150(8):778–86.CrossRefPubMedPubMedCentral
2.
Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1(7):888–96.CrossRefPubMed
3.
Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst. 2002;94:490–96.CrossRefPubMed
4.
Wheeler SB, Reeder-Hayes KE, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18:986–93.CrossRefPubMedPubMedCentral
5.
McVea KLSP, Minier WC, Palensky JEJ. Low-income women with early-stage breast cancer: physician and patient decision-making styles. Psychooncology. 2001;10:137–46.CrossRefPubMed
6.
Siminoff LA, Graham GC, Gordon NH. Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Educ Couns. 2006;62:355–60.CrossRefPubMed
7.
Polacek GNLJ, Ramos MC, Ferrer RL. Breast cancer disparities and decision-making among U.S. women. Patient Educ Couns. 2007;65(2):158–65.CrossRefPubMed
8.
Jibaja-Weiss ML, Volk RJ, Granchi TS, Neff NE, Robinson EK, Spann SJ, Aoki N, Friedman LC, Beck JR. Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy. Patient Educ Couns. 2011;84:41–8.CrossRefPubMed
9.
Durand M-A, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, Elwyn G. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9:e94670.CrossRefPubMedPubMedCentral
10.
Waljee JF, Rogers MAM, Alderman AK. Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol. 2007;25:1067–73.CrossRefPubMed
11.
Gillies K, Skea ZC, Campbell MK. Decision aids for randomised controlled trials: a qualitative exploration of stakeholders’ views. BMJ Open. 2014;4:e005734.CrossRefPubMedPubMedCentral
12.
Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006;61(2):173–90.CrossRefPubMed
13.
Thomson MD, Hoffman-Goetz L. Readability and cultural sensitivity of web-based patient decision aids for cancer screening and treatment: A systematic review. Med Informatics Internet Med. 2007;32:263–86.CrossRef
14.
Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AGK, Clay C, Légaré F, van der Weijden T, Lewis CL, Wexler RM, Frosch DL. “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak. 2013;13 Suppl 2:S14.CrossRefPubMed
15.
Wyatt KD, Branda ME, Anderson RT, Pencille LJ, Montori VM, Hess EP, Ting HH, LeBlanc A. Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters. Implement Sci. 2014;9:26.CrossRefPubMedPubMedCentral
16.
Hess EP, Knoedler MA, Shah ND, Kline JA, Breslin M, Branda ME, Pencille LJ, Asplin BR, Nestler DM, Sadosty AT, Stiell IG, Ting HH, Montori VM. The chest pain choice decision aid: a randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251–9.CrossRefPubMed
17.
Montori VM, Shah ND, Pencille LJ, Branda ME, Van Houten HK, Swiglo BA, Kesman RL, Tulledge-Scheitel SM, Jaeger TM, Johnson RE, Bartel GA, Melton LJ, Wermers RA. Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial. Am J Med. 2011;124:549–56.CrossRefPubMed
18.
Elwyn G, Pickles T, Edwards A, Kinsey K, Brain K, Newcombe RG, Firth J, Marrin K, Nye A, Wood F. Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial. Patient Educ Couns. 2016;99:571–7.CrossRefPubMed
19.
Mullan RJ, Montori VM, Shah ND, Christianson TJH, Bryant SC, Guyatt GH, Perestelo-Perez LI, Stroebel RJ, Yawn BP, Yapuncich V, Breslin MA, Pencille L, Smith SA. The diabetes mellitus medication choice decision aid. Arch Intern Med. 2009;169:1560–8.CrossRefPubMed
20.
Mann DM, Ponieman D, Montori VM, Arciniega J, McGinn T. The statin choice decision aid in primary care: a randomized trial. Patient Educ Couns. 2010;80:138–40.CrossRefPubMed
21.
Weymiller AJ, Montori VM, Jones LA, Gafni A, Guyatt GH, Bryant SC, Christianson TJH, Mullan RJ, Smith SA. Helping patients with type 2 diabetes mellitus make treatment decisions: statin choice randomized trial. Arch Intern Med. 2007;167:1076–82.CrossRefPubMed
22.
Sivell S, Edwards A, Manstead ASR, Reed MWR, Caldon L, Collins K, Clements A, Elwyn G. Increasing readiness to decide and strengthening behavioral intentions: Evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: www.​bresdex.​com). Patient Educ Couns. 2012;88:209–17.CrossRefPubMed
23.
Sivell S, Marsh W, Edwards A, Manstead ASR, Clements A, Elwyn G. Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex. Patient Educ Couns. 2012;86:179–88.CrossRefPubMed
24.
Durand M-A, Alam S, Grande S, Elwyn G. “Much clearer with pictures”: Using community-based participatory research to design and test a Picture Option Grid for underserved breast cancer patients. BMJ Open. 2016;6(2):e010008.CrossRefPubMedPubMedCentral
25.
Johnson RB, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004;33:14–26.CrossRef
26.
Thomas DR. A general inductive approach for qualitative data analysis. Popul English Ed. 2003;27:237–46.
27.
Wright KB. Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput Commun. 2006;10:00.
28.
Gosling SD, Vazire S, Srivastava S, John OP. Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. Am Psychol. 2004;59:93–104.CrossRefPubMed
29.
Garcia-Retamero R, Galesic M. Communicating treatment risk reduction to people with low numeracy skills: a cross-cultural comparison. Am J Public Health. 2009;99:2196–202.CrossRefPubMedPubMedCentral
30.
Galesic M, Garcia-Retamero R, Gigerenzer G. Using icon arrays to communicate medical risks: overcoming low numeracy. Health Psychol. 2009;28:210–6.CrossRefPubMed
31.
Gaissmaier W, Wegwarth O, Skopec D, Müller A-S, Broschinski S, Politi MC. Numbers can be worth a thousand pictures: Individual differences in understanding graphical and numerical representations of health-related information. Heal Psychol. 2012;31:286–96.CrossRef
32.
Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PKJ, King J, Lawson ML, Linder SK, Lipkus I, Ozanne E, Peters E, Timmermans D, Woloshin S. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak. 2013;13 Suppl 2 Suppl 2:S7.CrossRefPubMed
33.
Delp C, Jones J. communicating information to patients: the use of cartoon illustrations to improve comprehension of instructions. Acad Emerg Med. 1996;3:264–70.CrossRefPubMed
34.
Michielutte R, Bahnson J, Dignan MB, Schroeder EM. The Use of Illustrations and Narrative Text Style to Improve Readability of a Health Education Brochure. J Cancer Educ. 1992;7:251–60.CrossRefPubMed
35.
Nayak JG, Hartzler AL, Macleod LC, Izard JP, Dalkin BM, Gore JL. Relevance of graph literacy in the development of patient-centered communication tools. Patient Educ Couns. 2015;99(3):448–54.
36.
Witteman HO, Dansokho SC, Colquhoun H, Coulter A, Dugas M, Fagerlin A, Giguere AM, Glouberman S, Haslett L, Hoffman A, Ivers N, Légaré F, Légaré J, Levin C, Lopez K, Montori VM, Provencher T, Renaud J-S, Sparling K, Stacey D, Vaisson G, Volk RJ, Witteman W. User-centered design and the development of patient decision aids: protocol for a systematic review. Syst Rev. 2015;4:11.CrossRefPubMedPubMedCentral
37.
Witteman HO, Gavaruzzi T, Scherer LD, Pieterse AH, Fuhrel-Forbis A, Chipenda Dansokho S, Exe N, Kahn VC, Feldman-Stewart D, Col NF, Turgeon AF, Fagerlin A. Effects of Design Features of Explicit Values Clarification Methods: A Systematic Review. Med Decis Making. 2016;36(6):760–76.CrossRefPubMed
Metadata
Title
Assessing the acceptability and feasibility of encounter decision aids for early stage breast cancer targeted at underserved patients
Authors
Shama Alam
Glyn Elwyn
Sanja Percac-Lima
Stuart Grande
Marie-Anne Durand
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2016
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-016-0384-2

Other articles of this Issue 1/2016

BMC Medical Informatics and Decision Making 1/2016 Go to the issue

Research article

Time-to-event versus ten-year-absolute-risk in cardiovascular risk prevention – does it make a difference? Results from the Optimizing-Risk-Communication (OptRisk) randomized-controlled trial

Research article

Electronic reminders to facilitate longitudinal care: a mixed-methods study in general practices

Research article

Capturing judgement strategies in risk assessments with improved quality of clinical information: How nurses’ strategies differ from the ecological model

Research article

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature

Research article

The eClinical Care Pathway Framework: a novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections

Research article

Patient question set proliferation: scope and informatics challenges of patient question set management in a large multispecialty practice with case examples pertaining to tobacco use, menopause, and Urology and Orthopedics specialties