Sarah T Hawley's scientific contributionswhile working at Memorial Sloan-Kettering Cancer Center, New York, New York, United States and other institutions

Publications (187)

Publications citing this author (3684)

    • Because these data were collected at one university hospital, future studies would be served by examining other hospital and clinic settings across rural, suburban, and urban settings, to assess whether the findings extend to other clinical care settings. In addition, these findings may not describe the experiences of women of color and/or women in a variety of social or geographical locations (Barsotti Santos, Ford, dos Santos, & Vieira, 2014; Janz et al., 2008). It is also worth noting that this research was carried out in the USA.
    [Show abstract] [Hide abstract] ABSTRACT: Research has found that breast cancer and its treatments can have severe consequences for patients' sexual quality of life (SQoL); however, patients often report not knowing about possible impacts of treatment on their sexual well-being. This gap in information provision has been especially prominent for those diagnosed with metastatic breast cancer (MBC). To address the development of resources for patients diagnosed with MBC, the current study examined patients' descriptions of resources needed to support their SQoL in palliative care. Semi-structured interviews were conducted with 32 women diagnosed with MBC, aged 35–77 in a US breast cancer practice. Patients were asked to describe those issues that were most pressing and the supports they would find most valuable to improving their SQoL. Thematic analysis focused on what was missing in their care and what they wished they knew (or wish they had been told) about cancer and their SQoL. Four themes were developed from the interviews: (1) unexpected embodied loss and mourning; (2) silences; (3) desires for others' expertise, and (4) worries about normalcy. Findings across these themes highlighted how patients' psychosexual needs included both pressing instrumental needs as well as desires for support from oncological medical providers concerning the subjective experience of breast cancer.
    Full-text · Article · Oct 2015
    • Whether the CRC test received was for screening versus symptomdriven purposes is not altogether clear from claims (Schenck et al., 2008; Schenck et al., 2007). Consistent with best practices (Schenck et al., 2007Schenck et al., , 2008 ), we have included both screening and diagnostic procedures in our analysis. It is possible that in-office FOBTs done by providers after a rectal exam may have been included in our FOBT measure (as opposed to fecal screening done at home).
    [Show abstract] [Hide abstract] ABSTRACT: Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10–15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important.
    Full-text · Article · Dec 2016
    • Where studies used purely qualitative terms such as 'small', the risk magnitudes supporting these descriptions were unclear [57, 58]. Absolute risks (n = 85, 73 %) were presented more often than relative risk (n = 8, 7 %), although five (4 %) studies included both [14, 27,596061. Only two of eight studies using relative risk alone gave a baseline/underlying risk estimate to place the difference/change in overall risk in context [15, 33].
    [Show abstract] [Hide abstract] ABSTRACT: Discrete choice experiments (DCEs) are used to elicit preferences of current and future patients and healthcare professionals about how they value different aspects of healthcare. Risk is an integral part of most healthcare decisions. Despite the use of risk attributes in DCEs consistently being highlighted as an area for further research, current methods of incorporating risk attributes in DCEs have not been reviewed explicitly. This study aimed to systematically identify published healthcare DCEs that incorporated a risk attribute, summarise and appraise methods used to present and analyse risk attributes, and recommend best practice regarding including, analysing and transparently reporting the methodology supporting risk attributes in future DCEs. The Web of Science, MEDLINE, EMBASE, PsycINFO and Econlit databases were searched on 18 April 2013 for DCEs that included a risk attribute published since 1995, and on 23 April 2013 to identify studies assessing risk communication in the general (non-DCE) health literature. Healthcare-related DCEs with a risk attribute mentioned or suggested in the title/abstract were obtained and retained in the final review if a risk attribute meeting our definition was included. Extracted data were tabulated and critically appraised to summarise the quality of reporting, and the format, presentation and interpretation of the risk attribute were summarised. This review identified 117 healthcare DCEs that incorporated at least one risk attribute. Whilst there was some evidence of good practice incorporated into the presentation of risk attributes, little evidence was found that developing methods and recommendations from other disciplines about effective methods and validation of risk communication were systematically applied to DCEs. In general, the reviewed DCE studies did not thoroughly report the methodology supporting the explanation of risk in training materials, the impact of framing risk, or exploring the validity of risk communication. The primary limitation of this review was that the methods underlying presentation, format and analysis of risk attributes could only be appraised to the extent that they were reported. Improvements in reporting and transparency of risk presentation from conception to the analysis of DCEs are needed. To define best practice, further research is needed to test how the process of communicating risk affects the way in which people value risk attributes in DCEs.
    Full-text · Article · Feb 2014
    • It should here be noted that the reconstructive options offered were similar across the country. Previous results concerning associations with radiotherapy are mixed, with some being in line with our result [25,26] , and others indicating no as- sociation [6,42]. It should be noted that both indications for radiotherapy as part of treatment and guidelines for reconstruction before or after radiotherapy may vary from country to country.
    [Show abstract] [Hide abstract] ABSTRACT: We collected registry- and questionnaire-based data on socio-economic and health status, tumor- and treatment-related variables, and explored associations with receipt of reconstruction and information about treatment options in a nationwide cohort of Danish women, treated for primary breast cancer. A total of 594 women were available for analysis, 240 (40%) of these received reconstruction. Multivariate analyses showed that receipt of reconstruction was associated with 1) younger age at time of primary surgery (<36 years: OR = 10.04, [3.80-26.50], p < 0.001 and 36-49 years: OR = 2.48, [1.73-3.56], p < 0.001, compared to 50-60 year olds), 2) having received radiotherapy (OR = 0.57, [0.40-0.81], p = 0.002), 3) high income (Second quartile: OR = 1.74, [1.05-2.90], p = 0.033 and fourth quartile: OR = 2.18, [1.31-3.62], p = 0.003, compared with the lowest income quartile), and 4) ethnicity other than Danish (OR = 6.32, [1.58-25.36], p = 0.009). Health-related factors at the time of primary surgery (physical functioning, body mass index, smoking, use of alcohol, and comorbidity) were not associated with reconstruction. Odds of having received information about the option of reconstruction decreased by 8% per year of age in the multivariate analysis (OR = 0.92, [0.87-0.97], p = 0.003). In conclusion, younger age and not having been treated with radiotherapy was independently associated with reconstruction. In addition, higher income was also found to be associated with reconstruction despite free and equal access to reconstruction and healthcare in Denmark. Healthrelated factors were not associated with the use of reconstruction following mastectomy. Our findings underscore the need for physicians to ensure optimal level of information and accessibility to reconstruction for all women regardless of age, treatment, and socio-economic status. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jun 2015
    • The overall means of the four scales were high at 6.0 or higher (out of 7). This positively skewed distribution is slightly higher than what has been reported in other settings using the mHCCQ [13], and is consistent with numerous prior studies of communication and decisionrelated ratings in cancer patients demonstrating high patient-reported satisfaction21222324. These high scores may in part be inflated by patient response bias related to the desire to feel good about their treatment experience in order to minimize dissonance [25].
    [Show abstract] [Hide abstract] ABSTRACT: The Health Care Climate Questionnaire measures patient perceptions of their clinician's autonomy supportive communication. We sought to evaluate the psychometric properties of a modified brief version of the Health Care Climate Questionnaire (mHCCQ) adapted for breast cancer patients. We surveyed 235 women aged 20-79 diagnosed with breast cancer within the previous 18 months at two cancer specialty centers using a print questionnaire. Patients completed the mHCCQ for their surgeon, medical oncologist, and radiation oncologist separately, as well as the overall treatment experience. Exploratory factor analysis (EFA) using principal components was used to explore the factor structure. One hundred sixty out of 235 (68.1 %) women completed the survey. Mean age was 57 years and time since diagnosis was 12.6 months. For surgeon, medical oncologist, and radiation oncologist ratings separately, as well as overall treatment, women rated 6 dimensions of perceived physician autonomy support. Exploratory factor analysis indicated a single factor solution for each clinician type and for the overall experience. Further, all six items were retained in each clinician subscore. Internal consistency was 0.93, 0.94, 0.97, and 0.92 for the overall, surgeon, medical oncologist, and radiation oncologist scales, respectively. Hierarchical factor analysis demonstrated that a summary score of the overall treatment experience accounts for only 52 % of the total variance observed in ratings of autonomy support for the three provider types. These results describe the first use of the mHCCQ in cancer patients. Ratings of the overall treatment experience account for only half of the variance in ratings of autonomy support, suggesting that patients perceive and report differences in communication across provider types. Future research is needed to evaluate the relationship between physician communication practices and the quality of decision making, as well as other outcomes among cancer patients.
    Full-text · Article · Jul 2015
    • Communicating uncertainty can have a negative effect on patients, including heightening perception of risk, causing unnecessary worry [14], and decreasing ability to make decisions about care [15]. In contrast, other research suggests honest expressions of uncertainty may improve the doctor patient relationship [13], facilitating trust [11] , therapeutic effective- ness [16] and patient confidence [10] , and decreasing patient interest and participation in medical screening [6,17,18]. Studies investigating doctors' experiences of uncertainty, specifically in the context of PSA testing, are scarce. The experience of uncertainty is a challenging phenomenon to explore [14]; yet it is central to much of medical practice.
    [Show abstract] [Hide abstract] ABSTRACT: Background: Prostate-specific antigen (PSA) testing for prostate cancer is controversial. There are unresolved tensions and disagreements amongst experts, and clinical guidelines conflict. This both reflects and generates significant uncertainty about the appropriateness of screening. Little is known about general practitioners' (GPs') perspectives and experiences in relation to PSA testing of asymptomatic men. In this paper we asked the following questions: (1) What are the primary sources of uncertainty as described by GPs in the context of PSA testing? (2) How do GPs experience and respond to different sources of uncertainty? Methods: This was a qualitative study that explored general practitioners' current approaches to, and reasoning about, PSA testing of asymptomatic men. We draw on accounts generated from interviews with 69 general practitioners located in Australia (n = 40) and the United Kingdom (n = 29). The interviews were conducted in 2013-2014. Data were analysed using grounded theory methods. Uncertainty in PSA testing was identified as a core issue. Findings: Australian GPs reported experiencing substantially more uncertainty than UK GPs. This seemed partly explainable by notable differences in conditions of practice between the two countries. Using Han et al's taxonomy of uncertainty as an initial framework, we first outline the different sources of uncertainty GPs (mostly Australian) described encountering in relation to prostate cancer screening and what the uncertainty was about. We then suggest an extension to Han et al's taxonomy based on our analysis of data relating to the varied ways that GPs manage uncertainties in the context of PSA testing. We outline three broad strategies: (1) taking charge of uncertainty; (2) engaging others in managing uncertainty; and (3) transferring the responsibility for reducing or managing some uncertainties to other parties. Conclusion: Our analysis suggests some GPs experienced uncertainties associated with ambiguous guidance and the complexities of their situation as professionals with responsibilities to patients as considerably burdensome. This raises important questions about responsibility for uncertainty. In Australia in particular they feel insufficiently supported by the health care system to practice in ways that are recognisably consistent with 'evidence based' professional standards and appropriate for patients. More work is needed to clarify under what circumstances and how uncertainty should be communicated. Closer attention to different types and aspects of the uncertainty construct could be useful.
    Full-text · Article · Apr 2016
    • Its validity has been proven in several studies12131415 . Normative scores are available [16], and two studies supply tools for converting scores between PHQ-9 and other depression scales [17, 18]. The PHQ-9 is generally used in its original one-dimensional form (sum score of the 9 items), but several psychometric studies with multiple disease groups challenged the one-dimensional solution [19, 20] and showed that two-dimensional solutions fitted better2122232425.
    [Show abstract] [Hide abstract] ABSTRACT: Background The Patient Health Questionnaire PHQ-9 is a widely used instrument to screen for depression in clinical research. The first aim of this study was to psychometrically test the PHQ-9 in a large sample of cancer patients. The second aim was to calculate unbiased estimates of the depression burden for several cancer groups taking into account age and gender distributions. Methods A sample of 2,059 cancer patients with varying diagnoses were examined in this study six months after discharge from a rehabilitation clinic. A representative sample of 2,693 people from the general population served as controls. Expected PHQ-9 mean scores of the general population sample, regressed on age and gender, were calculated to enable a fair comparison of different groups of cancer patients. Results While the reliability (Cronbach’s alpha) for the PHQ-9 scale was good (alpha ≥ 0.84), the CFA fit indices of the one-dimensional solution were unsatisfactory in the patients’ sample. The factorial analysis confirmed two factors. PHQ-9 mean scores for 15 types of cancer are given, ranging from 4.0 (prostate) to 8.2 (thyroid gland). Differences between expected mean scores (derived from the general population) and raw mean scores of the cancer subsamples are reported that provide a better estimate of the depression burden. Conclusions The results confirmed that the PHQ-9 performs well in testing depression in cancer patients. Regression coefficients can be used for performing unbiased comparisons among cancer groups, not only for this study. The burden of patients with testis cancer and Hodgkin lymphoma is underestimated when age and gender are not taken into account.
    Full-text · Article · Dec 2016
    • This study reveals patient-provider discussions occurred in less than 20% of screening-eligible current and former smokers. Patient-provider discussions and subsequent healthcare provider recommendations are associated with increased cancer screening behavior in other types of cancer such as breast and colorectal with patient-provider discussions occurring in approximately 50–80% of screening eligible patients [15][16][17]. However, unlike many cancers, there is a higher level of stigma associated with lung cancer [18,19], which may be contributing to the overall low prevalence of patient-provider discussions in lung cancer screening .
    [Show abstract] [Hide abstract] ABSTRACT: Introduction The population-level patterns of electronic cigarette (e-cigarette) use among cancer survivors in the U.S. are unknown. The objective of this study was to examine the prevalence and correlates of e-cigarette use among cancer survivors in a nationally representative sample. Methods A cross-sectional analysis was conducted of the 2014 National Health Interview Survey of the U.S. non-institutionalized civilian population. The main study outcomes were the prevalence and correlates of ever and current e-cigarette use among adults with self-reported history of cancer, excluding non-melanoma skin cancer (N=2,695). Multivariable logistic regression analyses examined whether e-cigarette use differed by cigarette smoking status and demographic subgroups. The analyses were performed in 2015. Results The prevalence of e-cigarette use among adult cancer survivors was lower than the general population: 2.8% of cancer survivors reported currently using e-cigarettes and an additional 6.3% had previously used e-cigarettes but were not currently using them. Use of e-cigarettes was most common among cancer survivors who currently smoked cigarettes: 34.3% of current smokers were ever e-cigarette users and 15.6% were current e-cigarette users, compared with former smokers (2.7% ever and 1.4% current e-cigarette users) and never smokers (small sample/estimates unavailable). Conclusions E-cigarettes are not part of current evidence-based smoking-cessation strategies. However, the finding that cancer survivors who currently smoke cigarettes are more likely to use e-cigarettes highlights the importance of addressing e-cigarette use in patient–provider communications around tobacco cessation.
    Full-text · Article · May 2016
    • Characteristics of the provider and the client that influence accept-ability are often ignored. Client and provider characteristics have been shown to impede the ability of insurance coverage to increase utilization (Taylor, Van Scoyoc, & Tropman Hawley, 2002;Hofer & Katz, 1996). Equating availability of resources to access also misses the characteristics of providers and clients that may be barriers to access and goodness of fit between provider and client characteristics (Iwashyna, Chang, Zhang, & Christakis, 2002;Xu, 2002).
    [Show abstract] [Hide abstract] ABSTRACT: The Preventive Health Education and Medical Home Project (PHEMHP) is a predictive and contextual model intended to reduce low levels of health services utilization and improve preventive health techniques and disease self-management for low-income families in South Central Los Angeles, with the ultimate goal of attaching each child to a medical home. The model is designed to be implemented through educational and case management strategies. This paper presents the conceptual framework, critical intervention activities, and the different implementation variations the PHEMHP has already assumed. Implications for research, policy, and practice are discussed.
    Full-text · Article · Nov 2009
    • Screening in general was also avoided because of embarrassment due to the area of the body under investigation and having "zero dignity in the procedure" (42). Some people questioned the efficacy of colorectal cancer screening especially after witnessing rapidly growing cancers in friends and family (9,18,19,31,34,41,42,49,56,72,82,88,89): "[every]six months you go see your doctor and he said you got no cancer, next six month you see your doctor[now]he says you are going to die" (56). Lack of motivation for screening Several studies showed that individuals perceive colorectal cancer screening as less important in the context of other life obligations and priorities including other health concerns (13,18,35,36,43,45,46,50,55,56,59,90,91), and competing life demands (being a caregiver, work commitments; refs.
    [Show abstract] [Hide abstract] ABSTRACT: Screening reduces the incidence, morbidity, and mortality of colorectal cancer, yet participation tends to be low. We undertook a systematic review and meta-study synthesis of qualitative studies to identify facilitators and barriers to colorectal cancer screening participation. We searched major bibliographic databases for records published in all languages from inception to February 2015. Included primary studies that elicited views and perceptions towards colorectal cancer screening were appraised for relevance and quality. We used a two-stage synthesis to create an interpretation of colorectal cancer screening decisions grounded in primary studies; a thematic analysis to group themes and systematically compare studies and a meta-synthesis to generate an expanded theory of colorectal cancer screening participation. Ninety-four studies were included. The decision to participate in colorectal cancer screening depended on an individual's awareness of colorectal cancer screening. Awareness affected views of cancer, attitudes towards colorectal cancer screening modalities, and motivation for screening. Factors mediating awareness included public education to address misconceptions, primary care physician efforts to recommend screening, and the influence of friends and family. Specific barriers to participation in populations with lower participation rates included language barriers, logistical challenges to attending screening tests, and cultural beliefs. This study identifies key barriers, facilitators, and mediators to colorectal cancer screening participation. (C)2016 AACR.
    Full-text · Article · Apr 2016
    • To date, QOL research has focused almost exclusively on non- Hispanic White survivors [10] , with very limited research focusing on minorities. Yet, several studies have indicated that the QOL of African-American cancer survivors are significantly lower than their white counterparts [11, 12]. Physical activity (PA) is believed to remedy the QOL deficits experienced by breast cancer survivors and has been associated with enhanced survival and reduced risk of recurrence and mortality [13, 14].
    [Show abstract] [Hide abstract] ABSTRACT: IntroductionSeveral studies have indicated that the relationship between physical activity and quality of life is not directed but mediated through various pathways. The purpose of this study was to assess the role of cancer-related fatigue, disability, and functional status as potential mediators in African-American breast cancer survivors. Methods African-American breast cancer survivors (N = 135, mean age = 63) aged 55 years and older participated in a web-based survey consisting of measures assessing physical activity, functional status, cancer-related fatigue, disability, quality of life, and sociodemographic and medical characteristics. Structural equation modeling was used to assess the structural relationships among the constructs. ResultsThe initial structural model fit the data and revealed a significant relationship between physical activity and quality of life (β = 0.34, P < 0.01). Subsequent structural models with proposed complementary and mediating paths of fatigue, function, and disability fit the data. The adjusted model indicated that physical activity was no longer associated with quality of life (β = 0.11, P > 0.05) and mediated through pathways of functional status and fatigue (total β = 0.16, P < 0.01). The final adjusted model accounted for 32 % of the variance in quality of life. Conclusion Our data suggest that physical activity may be indirectly related to quality of life through pathways consisting of fatigue and functional status. Further longitudinal studies are needed to test the pathways through which varying levels of physical activity influence cancer-related and quality of life outcomes in minority cancer survivors.
    Full-text · Article · Oct 2016
    • Consequently, fish oil administration may retain hippocampal neurons and recovers cognitive deficit by activation of PI3K/AKT signaling [84]. Fish oil diet modifies the level of PTEN protein [85]. In this way, neuroprotection could be performed by certain diets involved in the PI3K/AKT/PTEN pathway.
    [Show abstract] [Hide abstract] ABSTRACT: Oxidative stress is considered to play key roles in aging and pathogenesis of many neurodegenerative diseases such as Parkinson's disease, which could bring DNA damage by cells. The DNA damage may lead to the cell apoptosis, which could contribute to the degeneration of neuronal tissues. Recent evidence suggests that PTEN (phosphatase and tensin homolog on chromosome 10) may be involved in the pathophysiology of the neurodegenerative disorders. Since PTEN expression appears to be one dominant determinant of the neuronal cell death, PTEN should be a potential molecular target of novel therapeutic strategies against Parkinson's disease. In addition, defects in DNA damage response and DNA repair are often associated with modulation of hormone signaling pathways. Especially, many observations imply a role for estrogen in a regulation of the DNA repair action. In the present review, we have attempted to summarize the function of DNA repair molecules at a viewpoint of the PTEN signaling pathway and the hormone related functional modulation of cells, providing a broad interpretation on the molecular mechanisms for treatment of Parkinson's disease. Particular attention will be paid to the mechanisms proposed to explain the health effects of food ingredients against Parkinson's disease related to reduce oxidative stress for an efficient therapeutic intervention.
    Full-text · Article · Jun 2016
    • Several of the selected studies presented secondary analyses from the BRFSS [16, 52, 73, 76], the NHIS [55, 74], or other pre-existing survey data [59, 66]. Other studies were conducted using medical charts abstraction [1, 81] or primary data collection through face-to-face inter- views [5, 66], telephone [8, 65, 69, 72, 79, 86], mailed [67, 71, 83, 87], and self-administered surveys[3, 12, 60, 68, 80]. Furthermore, some of these studies incorporated focus group discussions [53, 60] .
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Despite the benefits of regular Pap smear test for early detection of breast cancer, only a small number of women are engaged in this action. Objectives of this study were to characterize the modifying and cognitive factors associated with their Pap smear performance. Method: In this cross- sectional study, 350 women referred to health centers selected through the convenience sampling. The data collected by a self-administered questionnaire and standard Health Belief Model Scale. In data analysis by SPSS version 18 used suitable tests such as independent T test, Chi square test, logistic and linear regression model. Results: The results showed that 40.9% of the women had the history of Pap smear performance. Among the subscales perceived barrier (p= 0.00), seriousness (p= 0.03), benefits (p= 0.05), and health motivation (p= 0.00) were significantly associated to Pap smear performance, however only perceived barriers (OR= 0.23, 95% CI: 0.14, 0.38) were significant predictors. Conclusion: Knowledge had direct and indirect effect in Pap smear performance. Increasing knowledge about cervical cancer, and eliminating barriers especially in low literate and women with low pregnancy, are necessary. Key words: Cervical cancer; Health Belief Model; Pap smear test; Women.
    Article · Jan 2014
    • Decision aids are support tools intended to help patients engage in high-quality decision making for preference-sensitive decisions [3]. Preference-sensitive decisions are cases where there is more than one clinically appropriate option (eg, choosing between mastectomy and lumpectomy for treatment of breast cancer [4]), and as a result, depend on patients' values and preferences [3,5]. High-quality decision making occurs when well-informed patients consider evidence in the context of personal values and preferences to make a health decision.
    [Show abstract] [Hide abstract] ABSTRACT: Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.
    Full-text · Article · Jan 2016


    • Memorial Sloan-Kettering Cancer Center
      New York, New York, United States
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
    • Wayne State University
      Detroit, Michigan, United States
    • Harvard University
      Cambridge, Massachusetts, United States
    • Fox Chase Cancer Center
    • Baylor College of Medicine
      • Department of Family & Community Medicine
    • Duke University
      Durham, North Carolina, United States

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