Jeff Belkora, PhD, Associate Professor, Surgery and Health Policy Radiation, University of California, San Francisco

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www.jeffbelkora.com/evidence
List of references to literature Initial Setting: UCSF Breast Care Center
www.jeffbelkora.com/thanks
Sources of inspiration and support 600+ new patients annually making 1,300+ decisions
Surgery Chemotherapy
Lumpectomy 52% No chemotherapy 60%
Mastectomy 12% Adjuvant 27%
The Patient Support Corps Neo-adjuvant 12%
w/Reconstruction 27%
Jeff Belkora, PhD No Surgery 9% Chemo no surgery 1%
Associate Professor, Surgery and Health Policy Radiation Hormone therapy
University of California, San Francisco No 64%
Yes 35%
No 65% Yes 36%
Disclosure/Acknowledgment of current funding sources
University of California, San Francisco
The Dartmouth Institute for Health Policy and Clinical Practice
Informed Medical Decisions Foundation
California Breast Cancer Research Program
Robert Wood Johnson Foundation Dr. Laura Esserman
Quantum Leap Healthcare Collaborative Director
The Cancer Support Community
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Information and communication needs of patients Decision and communication aids to address needs
Reviewing decision Question-listing Summaries &
• At diagnosis: “Too much, too little, conflicting information” aids increases increases question- recordings increase
knowledge (1) asking (2) information recall (3)
• During visit: “I forgot to ask questions that were keeping me awake”
• After the visit: “I can’t recall – it all went in one ear and out the other”
Informed and involved patients have better outcomes (4)
(1) O'Connor et al: Decision aids…. Cochrane Syst Rev, 2003
(2) Kinnersley et al: Interventions before consultations …. Cochrane Syst Rev, 2007.
(3) Pitkethly et al: Recordings or summaries of consultations … Cochrane Syst Rev, 2008.
Image courtesy of www.speakingaboutpresenting.com (4) Griffin et al: Effect on health-related outcomes of interventions . Ann Fam Med, 2004. 2(6)
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Post-bac, pre-med interns =
coaches at UCSF Breast Care Center
How coaches can support patient needs
2005
Before Visit During Visit After Visit
2006
1. Send decision aids 3. Take Notes 5. Burn CD 2007
2008 2009
2010
2011
2. List questions 4. Make audio-recording 6. Print notes
2012
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RE-AIM Outcomes 2005-2010
Patient Support Corps - Strategic Direction
DA/CAs = decision/communication aids
• Reach: • Purpose
– DAs: 208 to 1,027 annually for a 5-year total of 3,208.
– Patients are informed and involved in their treatment decisions.
– CAs: from 142 to 348 annually for a 5-year total of 1,228.
• Effectiveness • Vision
– DAs: improvements in knowledge, decisional conflict – All patients have the support they need to be informed and involved.
– CAs: improvements in self-efficacy, question-asking, recall
• Adoption: • Mission
– DAs: 76% respondents review videos, 93% review booklets – Provide volunteers to assist patients with information and other needs .
– CAs: 83% respondents review summaries, 56% review recordings
• Implementation:
– 63 pre-medical interns to date performed with high fidelity and satisfaction
Expanded in 2012 from UCSF to Dartmouth
• Maintenance/Sustainability:
Now seeking funds to replicate program nationally
– Now expanding capacity with UC Berkeley student volunteers
– Spreading to other clinics around UCSF (e.g. orthopaedics, urology)