Research

Shared Decision Making

As Director of Research in Shared Decision Making in the Division of General Medicine at BIDMC, my research focuses on understanding, improving, and implementing shared decision-making in care.  Shared decision-making is a joint process between patients and clinicians where clinicians provide balanced and evidence-based information on an intervention, patients provide their perspective on the intervention based on a realistic understanding of the likely outcomes, and together they decide on a course of intervention. In my work I have used qualitative research methods to understand patient and clinician perspectives related to a decision, have developed conversation aids and patient decision aids, and have implemented these tools in practice.

Breast cancer screening and treatment

I am passionate about helping women, especially older women, understand the possible benefits and harms of mammography screening. In my research, I have studied breast cancer screening rates in women based on their breast cancer risk and health and I have examined outcomes of screening in older women. I developed a decision aid informing women 75 and older on the benefits (e.g., a small reduction in breast cancer mortality, early detection, reassurance) and harms (e.g., overdetection, false alarms, and radiation exposure) of mammography screening to help support their screening decisions.  I have also developed a conversation aid for clinicians to use to individualize mammography screening outcomes for older women to support shared decision-making during a vision.  Finally, I have studied breast cancer characteristics, treatment, and survival in older women which led me to develop a breast cancer treatment decision aid for women aged 70 and older with Stage I, estrogen receptor-positive, HER2 negative, breast cancer. I have tested my mammography screening decision aid for women aged 75 and older in a large clinician-cluster level randomized controlled trial and found that it increases older women's knowledge of the benefits and harms of mammography screening and reduces overuse of mammography screening.

Aging research

I am devoted to improving care and outcomes for older adults. I have developed a mortality index to help clinicians and older adults consider their life expectancy in their care decisions. My index has been accessed thousands of times at the ePrognosis website. In my research I have studied multiple areas in the care of older adults in addition to breast cancer screening and treatment I have studied older adults' use of telemedicine, participation in exercise, decisions about joint replacement surgery, colorectal and prostate cancer screening, and end-of-life care.