Results Summary and Professional Abstract
|This project's final research report is expected to be available by April 2021.|
2019 PCORI Annual Meeting Breakout Session
Navigating Complex Choices: Shared Decision Making across the Care Continuum
Increasingly, patients are faced with health decisions that have many options, uncertain outcomes, and benefits and harms that are valued differently by each individual. Shared decision making recognizes the importance of having patients and providers work together to select tests and treatments, though more clarity is needed on what it means and how it is implemented in day‐to‐day care. During this breakout session, panelists -- who included Kathleen Tebb, PhD -- highlighted how shared decision making includes evaluation of options based on care goals, concerns, and personal context of individuals.
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers requested that the researchers clarify their use of the terms, unprotected sex and effective contraception, noting that the study appeared to consider these terms in relation to unintended pregnancy only, and not in relation to sexually transmitted infections (STIs). The researchers clarified in the text that their focus was on unintended pregnancy and they did not evaluate changes in either pregnancy rates or STIs. Specifically, their focus was on educating participants about contraception options and their efficacy, in particular the superior efficacy of long-acting reversible contraception as birth control. The researchers also clarified that their app did describe the advantages of barrier-based contraception in preventing STIs and encouraged participants to use both methods when possible.
- The reviewers commented on the high attrition rate, with about half of participants dropping out of the study during the six-month study period. They asked if the researchers could offer insight on why attrition was higher in the intervention arm than in the control arm. The researchers added some thoughts on attrition rates in the report’s limitations section, including students providing incorrect follow-up information when they entered the study because of immigration fears, and that the attrition rates were comparable to those of other randomized controlled trials conducted online. The researchers indicated that one reason for improved follow-up rates in the control arm was because of increased efforts of staff in one of the control clinics, while other clinics considered these efforts infeasible and too time consuming. The researchers also stated that they did not feel comfortable hypothesizing further regarding the relationship between the high attrition rate and improved contraception use.
- The reviewers commented on the researchers’ assertion that the intervention and control groups were equivalent demographically at baseline and asked if there were tests demonstrating equivalence. The researchers said the groups were comparable because of the narrow inclusion criteria for the study: all participants were teenage female Latinas who had, had sex and were not using long-acting contraceptives at the time of enrollment. However, the intervention group participants were more likely to have visited the school-based health center where they were enrolled for the study for a pregnancy-related purpose and were more likely to be sexually active within the preceding three months. The researchers indicated that they included these variables as covariates in their comparisons.
Conflict of Interest Disclosures
The Conflict of Interest Disclosures for this project will be posted here soon.
Training and Education Interventions
Low Health Literacy/Numeracy