Abstract
BackgroundWomen of low socioeconomic status (SES) diagnosed with early stage breast cancer are less likely to be involved in treatment decisions. They tend to report higher decisional regret and poorer communication. Evidence suggests that well-designed encounter decision aids (DAs) could improve outcomes and potentially reduce healthcare disparities. Our goal was to evaluate the acceptability and feasibility of encounter decision aids (Option Grid, Comic Option Grid, and Picture Option Grid) adapted for a low-SES and low-literacy population.MethodsWe used a multi-phase, mixed-methods approach. In phase 1, we conducted a focus group with rural community stakeholders. In phase 2, we developed and administered a web-based questionnaire with patients of low and high SES. In phase 3, we interviewed patients of low SES and relevant healthcare professionals.ResultsData from phase 1 (n = 5) highlighted the importance of addressing treatment costs for patients. Data from phase 2 (n = 268) and phase 3 (n = 15) indicated that using both visual displays and numbers are helpful for understanding statistical information. Data from all three phases suggested that using plain language and simple images (Picture Option Grid) was most acceptable and feasible. The Comic Option Grid was deemed least acceptable.ConclusionOption Grid and Picture Option Grid appeared acceptable and feasible in facilitating patient involvement and improving perceived understanding among patients of high and low SES. Picture Option Grid was considered most acceptable, accessible and feasible in the clinic visit. However, given the small sample sizes used, those findings need to be interpreted with caution. Further research is needed to determine the impact of pictorial and text-based encounter decision aids in underserved patients and across socioeconomic strata.
Highlights
Women of low socioeconomic status (SES) diagnosed with early stage breast cancer are less likely to be involved in treatment decisions
The stakeholders felt that the layout of Comic Option Grid was crowded and confusing, making it more difficult to read
Four participants felt that Comic Option Grid was patronizing and overly simplified
Summary
Women of low socioeconomic status (SES) diagnosed with early stage breast cancer are less likely to be involved in treatment decisions They tend to report higher decisional regret and poorer communication. Alam et al BMC Medical Informatics and Decision Making (2016) 16:147 and benefits of available options, and to fail to exert their personal preferences It remains unclear, how best to promote participation in decision making, improve knowledge, and reduce disparities in patients of low SES diagnosed with early stage breast cancer [7,8,9]. Decision aids are delivered using diverse formats (e.g., webbased, video, audio, print), and have been shown to be effective in controlled contexts Their implementation in routine clinical settings remains difficult, partly due to a lack of attention to end-user acceptability [11]. Durand’s systematic review and meta-analysis indicate that decision aids adapted for underserved patients significantly improved outcomes in patients with lower SES and lower literacy [9]
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