The DECISIONS Survey

The Foundation is funding a national research project to understand how medical decisions are made. Investigators from the Survey Research Center and the Center for  Behavioral and Decision Sciences in Medicine at the University of Michigan are currently analyzing data collected as part of the National Survey of Medical Decisions (the DECISIONS Survey). Preliminary results reveal significant gaps and deficiencies in the way medical decisions are made in the United States.

Investigator Initiated Grants

The Foundation funds Investigator Initiated Grants to support research in medical decision-making by researchers and clinicians. Recently funded grants have investigated the effectiveness of methods to help people with low numeracy better understand medical information, the development of education materials to improve disease management in patients with advanced chronic kidney disease, and the use of interactive pictographs to improve risk communication.

Special Initiatives

The Foundation also funds Special Initiatives to gain additional insight in specific areas related to medical decision-making.  For example, as part of our Cardiac Initiative, we support research on the decision pathways that lead to cardiac revascularization and the history of decision-making in revascularization. Data from the Cardiac Initiative was recently published in the American Heart Association’s journal, Circulation.

Decision Quality Initiative

To better understand how to measure the quality of a medical decision (answering the question, “How do you know decision is a good one for the patient?”), we fund the Decision Quality Initiative. Researchers are currently at work identifying the key facts that both physicians and patients believe essential for making decisions about 19 preference-sensitive conditions. They also are creating a list of “patient goals and concerns” for each condition. Using focus groups and field testing, researchers are gathering the basic information needed to begin to assess decision quality—information absolutely essential for identifying interventions that truly help patients make informed medical decisions.

George Bennett Dissertation Fellowships and Robert Derzon Postdoctoral Grants

The George Bennett Dissertation Fellowships and Robert Derzon Post Doctoral Grants provide financial support for doctoral candidates, post-docs, and clinical fellows to conduct research on shared decision-making. Recent fellowship and grant recipients have investigated the decision-making needs of people with severe mental illness, the degree to which the quality of nurses’ decision support can be improved with a theory-based skills building intervention, and the effect of a direct-to-consumer campaign for a cervical cancer screening test on decision-making processes, patient satisfaction, and the clinical appropriateness of test use.

Internal Research Projects

In addition to these external projects, we conduct internal research projects to understand how to present complex data to patients in a way they can understand and apply. For example, Foundation researchers are currently studying the best methods for communicating outcome probability —the chance that a particular outcome will result from a particular treatment option—so that patients can make truly informed decisions when selecting from among various treatment options, including no treatment at all.

Links:

National Survey of Medical DecisionsInvestigator Initiated Grants Decision Quality InitiativeGeorge Bennett Dissertation FellowshipsRobert Derzon Postdoctoral Grants

References:

Lucas FL, Siewers AD, Malenka DJ, Wennberg DE. Diagnostic-therapeutic cascade revisited: coronary angiography, coronary artery bypass graft surgery, and percutaneous coronary intervention in the modern era. Circulation. published online Dec 8, 2008; DOI: 10.1161 / CIRCULATIONAHA. 108.789446.