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Improving Decision-Making

Salpingectomy for Ovarian Cancer Risk Reduction: Improving Utilization and Informed Decision-Making

New evidence on ovarian carcinogenesis shows that most ovarian cancers originate from the fallopian tubes rather than from the ovaries. This reveals a better opportunity for ovarian cancer prevention – prophylactic salpingectomy (removing the fallopian tubes while preserving the ovaries), which can effectively reduce ovarian cancer risk without the detrimental effects of hormonal deprivation. The overarching objective of this project is to improve quality of care for prophylactic salpingectomy by identifying provider- and patient-related barriers to utilization and promoting informed decision-making. Our specific aims are: 1) to identify distinct practice phenotypes in adopting prophylactic salpingectomy among physicians and compare physician attributes across these phenotypes; 2) to examine the role of social contagion among physicians in influencing salpingectomy uptake; 3) to ascertain physician perceived barriers to salpingectomy uptake and shared decision-making; and 4) to evaluate quality of decision-making regarding prophylactic salpingectomy from patients’ perspective and identify influencing factors.

Funding source: Agency for Healthcare Research and Quality
Principal Investigator: Xiao Xu

Developing A Digital Tool to Support Lung Cancer Screening

The goals of this project are to develop, test, and refine a digital tool to engage patients in lung cancer screening.

Funding source: Yale Cancer Center
Principal Investigator: Ilana Richman

Development of Cancer Survivorship Risk Models to Inform Pathways of Care

Cancer survivors have both unique oncologic and non-oncologic health needs related to their diagnosis, stage, treatment, and comorbidities. The current ‘one size fits all’ system of care is characterized by inefficient, unnecessary long-term oncologic follow-up for low-risk patients, yet often fails to provide appropriate non-cancer care for those at increased risk for other health problems. There is a critical and immediate need to provide robust risk estimates of oncologic and non-oncologic needs in cancer survivors available for managing physicians at the point-of-care. The research team will work to create validated, robust, and generalizable oncologic and non-oncologic risk algorithms and have them ultimately disseminated as a free web-based calculator to inform risk-stratified cancer survivorship. The resulting tool will apply to approximately half of all cancer survivors and create the evidence base needed to inform and implement risk-stratified survivorship pathways and improve the efficiency, appropriateness, and health equity of cancer patient care.

Funding source: American Cancer Society
Principal Investigator: Michaela Dinan

Supporting Personalized Decision-Making for Breast Cancer Screening for Older Women

The overarching goal of the proposed research is to help older women who are considering breast cancer screening make more informed decisions. To do this, we will generate improved estimates of the benefits and harms of screening that reflect the heterogeneity of life expectancy among older women. Then, in collaboration with patients, we will develop and test a decision aid that presents personalized estimates of benefits and harms from breast cancer screening. Our goal is to both generate better data to support decisions and also develop a decision aid as a tool that will allow women to access that data and ultimately make more informed decisions about breast cancer screening.

Funding source: National Cancer Institute
Principal Investigator: Ilana Richman
Understanding the Adoption and Impact of New Risk Assessment Technologies in Prostate Cancer Care

In this multi-method research study, we will evaluate how patients and providers understand and incorporate new risk assessment technologies into clinical decisions for prostate cancer. First, using population-level administrative claims data, we will define contemporary adoption patterns and study the association of prostate MRI and/or genomic testing with the initial management received by the patient. Then, to understand how both patients and providers perceive of these technologies in the process of decision-making, we will conduct in-depth, semi-structured qualitative interviews of patients with prostate cancer, as well as physicians who treat prostate cancer.

Funding source: National Institutes of Health (National Cancer Institute)
Principal Investigator: Michael Leapman