Project Details -

Ongoing

Delivering patient-centered, high-quality cancer care is a challenge exacerbated by the ‘preference-sensitive’ nature of several cancer decisions. For instance, treatment decisions for breast cancer, the most common cancer in women, are complex as there are usually several appropriate treatment options with differing risks, benefits, and implications for the patient’s life. Patients need to be involved in these preference-sensitive decisions, but patients report knowing only 50 percent of the information needed to make a decision, and less than half of patients make high-quality decisions about their care. Patients who are less involved in their breast cancer decision making have lower satisfaction and higher regret with chosen treatments. Numerous decision aids have been developed to support patient-centered decision making in breast cancer. However, sustained implementation and use of these tools has been limited.

This research will design and evaluate a COMputerized PAtient-centered Collaborative Technology (COMPACT) to support personalized breast cancer decision making, with the goals of improving outcomes, increasing patient satisfaction, and reducing healthcare costs. COMPACT will be designed using human factors engineering principles and a human-centered design (HCD) approach, and will include clinician- and patient-facing dashboards in the electronic health record and patient portal.

The specific aims of the research are as follows:

Elucidate design requirements for a system to support personalized decision making in breast cancer.
Apply an HCD process to develop and evaluate COMPACT.
Evaluate the COMPACT prototypes in a high-fidelity, scenario-based simulation.

A human factors engineering work system analysis will be done to understand the sociotechnical work system around breast cancer care. A combination of interviews and observations of patients and clinicians will inform detailed care process and patient journey maps that will support COMPACT’s design. Collaborative design sessions will be held with patients, their caregivers, and clinicians to inform the development of the user interface. Formative usability testing and a heuristic evaluation will be done leading to design improvements to prototypes. Scenario-based simulations with patients and clinicians will be used in the evaluation phase of the research, analyzing usefulness, usability, and acceptance of COMPACT. The results of this research will be used to inform a future randomized controlled trial of COMPACT to study its impact on patient care.

Technology to Support Personalized Care Decisions for Breast Cancer Treatment

Theme:

Engaging and Empowering Patients

Subtheme:

Using Digital Shared Decision-Making Tools to Support Personalized Decision Making

Enhancing personalized care decisions, using technology designed with human factors engineering approaches, can improve breast cancer care quality.

Patients face an array of breast cancer treatment options

Breast cancer is the second most common cancer in women, but treatment decisions can be complex. Each treatment option brings different benefits, risks (e.g., short- and long-term side effects), and implications (e.g., treatment duration) for the patient. Women need to be fully informed of all viable treatment options, and their treatment decisions should be based on their values, preferences, and goals.

It is challenging to successfully discuss all relevant factors in time-constrained clinical encounters, and patients may not divulge all personal issues and needs. For example, a mother with small children may have constraints given her family needs, while chemo-induced brain fog may significantly affect the working life of a teacher. These factors can have major impacts on the patient and their quality of life. How can we better support women in weighing the pros and cons of treatment options so that the path they select best aligns with their values, preferences, and goals?

“One of the patient advisory members is a long-distance runner. She had breast cancer and had to have chemotherapy and got significant neuropathy in her feet and in her hands, which can be a common side effect of chemotherapy, and she's no longer able to run. Luckily, she's in remission, but running was a really big hobby of hers, a passion of hers. I am trying to think of things like that, that might become a part of the conversation when patients are diagnosed and choosing between different options.”- Dr. Megan Salwei

Technology will help support team decision making in breast cancer

To better support more comprehensive, personalized decision making when selecting breast cancer treatment options, Dr. Megan Salwei and a team from Vanderbilt University Medical Center are developing a tool called COMputerized PAtient-centered Collaborative Technology (COMPACT).

COMPACT will gather relevant information from patients on their preferences, goals, and questions ahead of a patient’s visit via a patient portal. It will then integrate that information with evidence-based guidelines and medical data from the woman’s electronic medical records, such as age, genetic testing results, and tumor type, to generate patient-optimized treatment options. The tool will present this information in a shared display to facilitate real-time conversations between clinicians, patients, and family caregivers as they make treatment decisions.

COMPACT will be unique compared to other decisions aids because it will support the entire decision-making process in a woman’s breast cancer journey: before, during, and after initial treatment discussions. The technology will support patients throughout their cancer journey by monitoring treatment progress and supporting additional decision making when the care trajectory deviates from the desired path.

The system will be designed with users in mind

COMPACT will be developed using human factors engineering, which focuses on designing systems to support the strengths and constraints of the people within the system. This ensures the COMPACT technology will fit patients’ and providers’ needs in the environment that it will be used. As Dr. Salwei noted, “The human-centered design process ensures that whatever I develop is supporting the users, which would be patients as well as clinicians.”

Once developed, the team will evaluate COMPACT in a simulated environment to understand how users interact with the technology, record how long it takes them to have conversations with the tool, and determine if it improves knowledge and confidence of decision making. Ultimately, Dr. Salwei hopes the results of this grant will inform a future randomized controlled trial of COMPACT to study its impact on patient care in a real-world setting.