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Integrating Shared
Decision-Making for Early-Stage
Breast Cancer Treatment

Reading Time: 3 minutes

How to make hard decisions easier.

Oregon Surgical Wellness has teamed up with The Dartmouth Institute for Health Policy and Clinical Practice to help women in North America diagnosed with early-stage breast cancer make informed decisions about treatment options. As Lane County’s highest volume center taking care of more than 300 breast cancer patients annually, Oregon Surgical Wellness, LLC was recently selected as a learning collaborative partner by the Patient-Centered Outcomes Research Institute (PCORI) at The Dartmouth Center for Shared Decision Making. Drs. Henderson and Kollmorgen are honored to be working side by side with leading decision scientists at Dartmouth Hitchcock Medical Center. Over the next 24-month period, Oregon Surgical Wellness will be a test site; using specifically designed patient centered option grids for shared decision making. Their focus will be on helping women with early-stage breast cancer make informed choices for treatment. They are thrilled to be selected as one of only 30 collaborative partners across the Americas. Phase 1 research suggests that one of the most effective ways to improve health outcomes and increase people’s satisfaction with care is through better communication and more responsive, patient-centered decision making.

This model for care—often called shared decision-making (SDM)—has at its core a strong partnership between health care provider and patient. The Dartmouth Institute is at the forefront of patient engagement and shared decision-making research, working to develop tools to improve communication between patients and healthcare providers and strategies for integrating SDM into healthcare practice at many levels. A team of researchers at Dartmouth’s Geisel School of Medicine and The Dartmouth Institute, led by Glyn Elwyn, MD, PhD, MSc, has received a $2.1 million funding award from the PCORI to develop a shared decision-making process to help women with breast cancer choose their surgical treatment options using the SHAIR OptionGrid in three different languages (English, Spanish and Chinese) and in picture format. Their methods will soon be studied further right here in Lane County. The strategy to be implemented at 30 sites including Lane County includes four components:

  • An assessment of each organization’s readiness for SDM and a tailored strategy to address potential organizational barriers to implementation
  • Online or in-person training of clinical teams
  • Implementation of a paper-based text or picture version and/or a web-based interactive OptionGrid encounter decision aids
  • Integration of the new evidence and the SDM approach into existing clinical practice guidelines

Dartmouth’s research, as well as many other studies, support the idea that well-designed conversation aids lead to improved patient education and increased SDM, which is highly valued by patients and widely recognized by healthcare professionals as the moment of epiphany in the patient-provider relationship. Drs. Henderson and Kollmorgen feel strongly that these conversation aids be made available to all women with early-stage breast cancer on a routine basis. In keeping with their mission of being an innovation-focused organization passionate about continuous improvement, Drs. Henderson and Kollmorgen are ramping up the program called SHAIR Collaborative by training their staff and attending national webinars for participants. The team at Oregon Surgical Wellness is confident this emerging approach, unique in Lane County, will add tremendous value to the comprehensive care of their breast cancer patients. Most importantly, they feel these new tools will ensure that every patient has a voice and a choice in their care. Informed decisions result in improved patient engagement and better decisions. Better decisions in turn lead to better outcomes, an exciting new advance for our community’s breast cancer patients.

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