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AHRQ Research Studies Date
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- (-) Cancer (14)
- Cancer: Breast Cancer (6)
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- Clinician-Patient Communication (3)
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- (-) Decision Making (14)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedDalton AF, Golin CE, Morris C
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
This research studied the effects of a patient decision aid on preferences for colorectal cancer (CRC) screening among adults aged 76 to 84 years. Participants were recruited from 14 community-based primary care practices who were not up to date with screening and had an appointment within 6 weeks. They were randomized to receive the intervention or control. Among the 424 participants, mean age was 76.8, 248 were women, and 333 were White. There were no statistically significant differences found in patient preferences between the health groups. Additional studies that are appropriately powered were recommended.
AHRQ-funded; HS021133.
Citation: Dalton AF, Golin CE, Morris C .
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
JAMA Netw Open 2022 Dec;5(12):e2244982. doi: 10.1001/jamanetworkopen.2022.44982..
Keywords: Elderly, Decision Making, Screening, Cancer: Colorectal Cancer, Cancer
Schumacher JR, Zahrieh D, Chow S
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
This paper describes the protocol for a multisite randomized trial to test the impact of a newly developed decision aid to increase socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. The study will be conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). A stepped-wedge design with clinics will be randomized to the time of transition from usual care to the decision aid arm. Study participants will be female, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection will include a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. A subset of patients, surgeons, and clinic stakeholders will participate in interviews and focus groups.
AHRQ-funded; HS025194.
Citation: Schumacher JR, Zahrieh D, Chow S .
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
BMJ Open 2022 Nov 17;12(11):e063895. doi: 10.1136/bmjopen-2022-063895..
Keywords: Cancer: Breast Cancer, Cancer, Patient and Family Engagement, Decision Making, Patient-Centered Healthcare, Surgery, Women
Ross RL, Rubio K, Rodriguez HP
Mammography and decision aid use for breast cancer screening in older women.
This study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2016-17 Medicare fee-for-service beneficiary data from eligible beneficiaries aged 65-74 years. Findings showed that health information technology-enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision.
AHRQ-funded; HS022241; HS024075.
Citation: Ross RL, Rubio K, Rodriguez HP .
Mammography and decision aid use for breast cancer screening in older women.
Am J Prev Med 2022 Oct;63(4):630-35. doi: 10.1016/j.amepre.2022.04.014..
Keywords: Imaging, Screening, Decision Making, Cancer: Breast Cancer, Women, Prevention, Cancer, Elderly
Wernli KJ, Smith RE, Henderson LM
Decision quality and regret with treatment decisions in women with breast cancer: pre-operative breast MRI and breast density.
The authors evaluated self-report of decision quality and regret with breast cancer surgical treatment by pre-operative breast MRI use in women recently diagnosed with breast cancer. They found that breast MRI use in the diagnostic work-up of breast cancer does not negatively alter women's perceptions of surgical treatment decisions in early survivorship.
AHRQ-funded; HS018366.
Citation: Wernli KJ, Smith RE, Henderson LM .
Decision quality and regret with treatment decisions in women with breast cancer: pre-operative breast MRI and breast density.
Breast Cancer Res Treat 2022 Aug;194(3):607-16. doi: 10.1007/s10549-022-06648-7..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Outcomes Research
Wasp GT, Knutzen KE, Murray GF
Systemic therapy decision making in advanced cancer: a qualitative analysis of patient-oncologist encounters.
This study sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). The authors performed content analysis of outpatient oncology encounters at two US National Cancer Institute-designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development with a combination of random and purposive sampling. Among 31 randomly sampled dyads with 3 encounters each (93 total), systematic therapy decision making was discussed in 90% encounters. Only 34 oncologists broached limiting therapy, which 27 framed as temporary; nine as completion of a standard regime; and five as permanent discontinuation. Thematic analysis found that that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation.
AHRQ-funded; HS022242.
Citation: Wasp GT, Knutzen KE, Murray GF .
Systemic therapy decision making in advanced cancer: a qualitative analysis of patient-oncologist encounters.
JCO Oncol Pract 2022 Aug;18(8):e1357-e66. doi: 10.1200/op.21.00377..
Keywords: Decision Making, Cancer, Clinician-Patient Communication
Tsang M, DeBoer RJ, Garrett SB
Decision-making about clinical trial options among older patients with metastatic cancer who have exhausted standard therapies.
The purpose of this study was to examine the potential reasons for and responses to older adults’ under enrollment in phase 1 cancer clinical trials. The researchers conducted 101 in-depth qualitative interviews with 39 adults aged 65 and older with advanced cancer and asked about their experiences with the trials. The data was analyzed to identify the participants’ understanding of clinical research, their perceptions of early phase trials, and their experiences with enrollment in the trials. The study found that participants over the age of 70 were less enthusiastic about participation in clinical trials, although they did not mention age as a limitation to participation. Findings indicated that participation in clinical trials was an interactive, ongoing process, in which older adults relied on their oncologist for guidance and discussion. The researchers concluded that older adults rely on their oncologist to navigate the perceived complexities of phase 1 trial enrollment, and that acknowledgement of those complexities via shared decision-making can help prevent under-enrollment.
AHRQ-funded; HS022241.
Citation: Tsang M, DeBoer RJ, Garrett SB .
Decision-making about clinical trial options among older patients with metastatic cancer who have exhausted standard therapies.
J Geriatr Oncol 2022 Jun;13(5):594-99. doi: 10.1016/j.jgo.2022.01.012..
Keywords: Elderly, Cancer, Decision Making, Quality of Life
Rosenberg SM, Gierisch JM, Revette AC
"Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ.
This study investigated the impact of a ductal carcinoma in situ (DCIS) diagnosis by engaging self-identified patients regarding their experience. Findings showed that, in a large, national sample, participants with a history of DCIS reported confusion and concern about the diagnosis and treatment, which caused worry and significant uncertainty.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Gierisch JM, Revette AC .
"Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ.
Cancer 2022 Apr 15;128(8):1676-83. doi: 10.1002/cncr.34126..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Healthcare, Clinician-Patient Communication, Patient and Family Engagement, Communication
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Decision Making
Chen MM, Hughes TM, Dossett LA
Peace of mind: a role in unnecessary care?
This article discusses the role peace of mind plays in unnecessary cancer preventative care, including unnecessary screenings and surgeries. For example, shared-decision making is recommended by the USPSTF for PSA-based screening but if the decision to screen is emotion-based, then shared decision-making guidelines may not be effective. A number of studies have shown that peace of mind has been implicated as a key patient-centered outcome driving the increased utilization of contralateral prophylactic mastectomy (CPM). Overdiagnosis and overtreating of thyroid cancer have resulted in an accelerating rate of total thyroidectomies relative to lobectomies for small papillary cancers in the past decade even though there is no evidence showing better survival rates. Quality-of-life studies have not shown better outcomes to patients who do chose the more radical treatment. The authors recommend that clinicians undergo training in cognitive debiasing strategies and more training in empathic communication and risk communication techniques to decrease the potential negative influence of peace of mind.
AHRQ-funded; HS026030.
Citation: Chen MM, Hughes TM, Dossett LA .
Peace of mind: a role in unnecessary care?
J Clin Oncol 2022 Feb 10;40(5):433-37. doi: 10.1200/jco.21.01895..
Keywords: Patient-Centered Healthcare, Decision Making, Cancer
Dossett LA, Mott NM, Bredbeck BC
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
The purpose of this study was to examine the role that an individual’s maximizing-minimizing trait, an inherent preference for more or less medical care, may influence the preference for low-value care in the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women 70 years of age or higher with early-stage, hormone-receptor positive invasive breast cancer. The researchers recruited women 70 years of age or higher (n=1600) who were maximizers (515), minimizers (550), or neutral (535), and presented them with a hypothetical breast cancer diagnosis and then randomized exposure to one of three follow-up messages. Messages included: 1) maximizer-tailored, 2) minimizer-tailored, or 3) neutral. The study reported that higher maximizing tendency correlated positively with electing both SLNB and radiotherapy on logistic regression. Any maximizer- or minimizer-tailoring decreased preference for SLNB in maximizing and neutral women but had no effect in minimizing women. Tailoring had no impact on radiotherapy decision, except for an increased probability of minimizers electing radiotherapy when presented with maximizer-tailored messaging. The study concluded that among women facing a hypothetical breast cancer diagnosis, tendencies for maximizing-minimizing are correlated with preferences for treatment.
AHRQ-funded; HS026030.
Citation: Dossett LA, Mott NM, Bredbeck BC .
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
J Surg Res 2022 Feb;270:503-12. doi: 10.1016/j.jss.2021.10.005..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Women, Decision Making, Clinician-Patient Communication, Communication
Shipe ME, Baechle JJ, Deppen SA
Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. In this study, the investigators sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma.
AHRQ-funded; HS026122.
Citation: Shipe ME, Baechle JJ, Deppen SA .
Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
Surg Endosc 2021 Nov;35(11):6081-88. doi: 10.1007/s00464-020-08101-6..
Keywords: COVID-19, Cancer, Surgery, Decision Making, Risk
Sella T, Poorvu PD, Ruddy KJ
Impact of fertility concerns on endocrine therapy decisions in young breast cancer survivors.
The diagnosis and treatment of breast cancer can have profound effects on a young woman's family planning and fertility, particularly among women with hormone receptor-positive breast cancer. In this paper the authors discuss the Young Women's Breast Cancer Study, a multicenter cohort of women aged 40 years or younger and newly diagnosed with breast cancer from 2006 to 2016. The investigators concluded that concern about fertility was a contributor to adjuvant ET decisions among a substantial proportion of young breast cancer survivors.
AHRQ-funded; HS023680.
Citation: Sella T, Poorvu PD, Ruddy KJ .
Impact of fertility concerns on endocrine therapy decisions in young breast cancer survivors.
Cancer 2021 Aug 15;127(16):2888-94. doi: 10.1002/cncr.33596..
Keywords: Cancer: Breast Cancer, Cancer, Women, Pregnancy, Decision Making
Wallner LP, Banerjee M, Reyes-Gastelum D
Multilevel factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer.
The use of radioactive iodine (RAI) for low-risk thyroid cancer is common, and variation in its use exists, despite the lack of benefit for low-risk disease and potential harms and costs. The objective of this study was to simultaneously assess patient- and physician-level factors associated with patient-reported receipt of RAI for low-risk thyroid cancer. The investigators concluded that physician perspectives and attitudes about using RAI, as well as patient volume, influenced RAI use for low-risk thyroid cancer.
AHRQ-funded; HS024512.
Citation: Wallner LP, Banerjee M, Reyes-Gastelum D .
Multilevel factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer.
J Clin Endocrinol Metab 2021 May 13;106(6):e2402-e12. doi: 10.1210/clinem/dgab139..
Keywords: Cancer, Practice Patterns, Decision Making, Risk
Rhoten BA, Sellers JI, Baraff B
A qualitative examination of patient priorities and preferences during treatment decision-making for recurrent head and neck cancer.
Patients with recurrent head and neck cancer (HNC) may feel overwhelmed at the prospect of having to consider treatment options particularly if they recently completed treatment for their primary disease or when they have no options that may lead to long-term survival. The purpose of this study was to examine patient priorities and preferences during treatment decision-making for recurrent HNC.
AHRQ-funded; HS022990.
Citation: Rhoten BA, Sellers JI, Baraff B .
A qualitative examination of patient priorities and preferences during treatment decision-making for recurrent head and neck cancer.
Support Care Cancer 2021 Jan;29(1):377-85. doi: 10.1007/s00520-020-05488-9..
Keywords: Cancer, Decision Making, Quality of Life