Sunday, May 5, 2024
5/5/2024
Project Summary/Abstract Breast surgeons have been highly successful at deimplementing some low-value surgical care but less successful at deimplementing care that is preference-sensitive. Sentinel lymph node biopsy for women =70 years of age (SLN over 70) and contralateral prophylactic mastectomy (CPM) have been deemed low-value by national surgical societies. However, use has remained unchanged or even increased over time. Patients are frequently motivated to pursue these operations because of perceived prognostic value or to minimize future cancer risk. However, while SLN over 70 and CPM have no impact on survival, they may have a substantial negative impact on psychosocial, physical, and financial outcomes. Surgeons endorse these operations should not be routinely performed, but also acknowledge that the perceived benefits of the procedures can outweigh the potential risks for some women. A critical gap towards supporting deimplementation of low-value preference-sensitive care is our understanding of how decisions are made within the patient-surgeon interaction. By directly studying patterns of conversation associated with deimplementation, we can understand whether patients’ preferences are driving the treatment plan and what tools may help surgeons support patients in these conversations. In an R01 funded study (NCT03766009), we audio-recorded 594 surgical consultations from a racially and socioeconomically diverse sample of breast cancer patients cared for at academic and community centers across the United States. These consults have been transcribed and the content categorized. The objective is to use this novel dataset to understand the relationship between what surgeons and patients say during the consult, and how deimplementation decisions for SLN over 70 and CPM are made. We have three aims: Aim 1, test the association between performance of shared decision making and deimplementation of preference-sensitive low-value care; Aim 2, identify patterns of surgeon-patient interactions that are associated with deimplementation of preference-sensitive low-value care; Aim 3, develop a conversation guide to support surgeons in discussing preference-sensitive low-value care. This R21 study will generate key understanding about how decisions to deimplement preference-sensitive low-value care are made within the patient-surgeon interaction. By combining our insights with the existing literature on surgeon and patient attitudes and beliefs, we will develop a multi-faceted strategy to support deimplementation of preference-sensitive low-value care which can then be tested in a future R01 study.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
