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Research in Patient Decision Support

Celia Wills
East Lansing, MI

I am currently engaged in two newly-funded projects conducting research in patient decision support. The first, "Information Interpretation in Patient Decision Support," funded by the Agency for Healthcare Research and Quality, is with PI Margaret Holmes-Rovner. The second, "Patient Decision Making About Antidepressant Medication," is a Clinical Scientist Career Development Award awarded by NIMH, for which I am the Principal Investigator.

Both projects focus on how patients evaluate information and make decisions relevant to their own health needs. The common goal of both projects is to develop knowledge for understanding how patient decision support interventions should be designed to foster more effective shared decision making between patients and health care providers.

The first project compares populations varied by ethnicity (African American/Caucasian) and education (with/without college education) to investigate patients' interpretation of information about risks and benefits of treatment decisions for benign prostatic hyperplasia (SDP/BPH) and the impact of such information on their decisions. We propose to examine information types commonly used to communicate risks and benefits of medical treatments to patients: statistical information, graphical lists, graphical drawings and diagrams, and patient interviews.

Research questions to be addressed are:

1) Do information types differentially affect participants' likelihood to choose a treatment?

2) Do information types differentially affect participants' interpretation of importance and salience of the information?

3) What new questions or concerns are raised for participants by full information?

The second project is an investigation of patients' decisions to decline or discontinue depression medication, despite its effectiveness and availability. Little is known about how people make depression treatment decisions, including key influences on decision making and appropriateness of decision making as related to health status and health system outcomes. Research on patient decision making can provide information that is needed to develop patient-focused interventions to improve depression treatment outcomes.

The goal of research in the first project is to describe relationships over time between patient decision making, medication use, health status, and cost and utilization of health services outcomes. Based on findings from the first project, a patient decision support intervention for primary care depression treatment will be pilot-tested for feasibility in the second project. The long-term goal is to improve the quality of primary care services for depression through implementation of decision support interventions for diverse populations of patients undergoing depression treatment.

Contact Celia Wills

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