A Multi-pronged Intervention to Initiate Shared Decision-making on Medical Tests and Care Cascades in the Primary Care Setting
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Brigham and Women's Hospital
- Enrollment
- 329
- Locations
- 1
- Primary Endpoint
- Shared Decision-Making Process 4 Survey
Study Overview
Brief Summary
The purpose of this randomized controlled trial is to evaluate the impact of patient and provider facing educational materials and peer comparison on medical testing conversations during annual physicals. The investigators hypothesize that education materials and peer comparison will improve conversation quality about medical testing decisions.
Detailed Description
Medical tests may show unexpected findings leading to additional tests, treatments, and visits that cost money and take time but may not have benefits. This is a prevalent issue with major consequences for patients and clinicians. Making informed decisions about when to order medical tests may help avoid unnecessary costs and worry. However, doctors don't always have detailed conversations about medical testing and there are patient gaps in knowledge. The investigators hypothesize that education materials and peer comparison to promote conversations about medical tests will improve conversation quality about medical testing decisions. The investigators have developed patient and provider-facing interventions to educate on and promote conversations about the uses and consequences of medical tests, and the investigators will test the impact of this just-in-time educational and peer comparison intervention on the likelihood of patients having productive conversations about medical tests. The effects of the intervention will be assessed using surveys before and after the study. This work has the potential to help patients feel more supported by their healthcare system, empower patients to participate in shared decision-making, and build trust between patients and clinicians.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •(Physicians):
- •Primary care physicians at Brigham and Women's Hospital
- •In active practice
- •Inclusion criteria (Patients):
- •Adults age 18 years old or older
- •English-speaking
- •Access to email
- •Did not opt out of receiving research invitations from health system
- •Patients of participating physicians
- •Scheduled annual physical during the study period
Exclusion Criteria
- Not provided
Arms & Interventions
Intervention Arm
Intervention arm physicians will receive an email with feedback on how they compare to their peers in aggregate on test ordering during annual physicals, along with physician-facing education materials. This email will be sent before each patient study visit for all patients in the study. Participating patients of intervention arm physicians will receive patient education materials one to two days before their study visit.
Intervention: Patient education materials (Behavioral)
Intervention Arm
Intervention arm physicians will receive an email with feedback on how they compare to their peers in aggregate on test ordering during annual physicals, along with physician-facing education materials. This email will be sent before each patient study visit for all patients in the study. Participating patients of intervention arm physicians will receive patient education materials one to two days before their study visit.
Intervention: Physician peer-comparison email (Behavioral)
Intervention Arm
Intervention arm physicians will receive an email with feedback on how they compare to their peers in aggregate on test ordering during annual physicals, along with physician-facing education materials. This email will be sent before each patient study visit for all patients in the study. Participating patients of intervention arm physicians will receive patient education materials one to two days before their study visit.
Intervention: Physician education materials (Behavioral)
Control Arm
Control arm physicians receive an email with information on the general visit preparation tips that their patients will receive. Participating patients of control arm physicians will receive general visit preparation tips one to two days before their study visit.
Intervention: General visit preparation materials (Behavioral)
Outcomes
Primary Outcomes
Shared Decision-Making Process 4 Survey
Time Frame: Within two weeks after visit
Composite score of survey items completed by the patient after physician visit. Min 0, Max 4 (higher is better).
Secondary Outcomes
- Satisfaction with testing discussion(Within two weeks after visit)
- Patient knowledge(Within two weeks after visit)
- Presence of testing discussion(Within two weeks after visit)
- Discussion of next steps(Within two weeks after visit)
- Whether doctor explained tests in a way that was easy to understand(Within two weeks after visit)
Investigators
Ishani Ganguli MD, MPH
Assistant Professor of Medicine
Brigham and Women's Hospital