Although patient preference is critical to selecting the optimal treatment, research discrepancies between patient preferences and care received. These shortcomings threaten patient autonomy, place patient safety at risk, and lead to costly and unnecessary treatments. Shared decision-making (SDM) can lead to better alignment of patient preferences and care received. In SDM, patients and providers form a partnership to make a decision based on the best available evidence that is weighted according to the patient's values, preferences, and healthcare goals. However, SDM is underutilized and available tools to facilitate it (called decision aids) are inadequate overlooking the needs of millions of Americans including those with limited health literacy. Embodied conversational agents (ECA) are computer animated characters that simulate face-to-face conversation and could be used to facilitate SDM. These tools may be particularly useful among patients with limited health literacy as may be easier to use than other computer interfaces. In addition, these agent interfaces could overcome the passivity limitations of other methods and promote active learning and decision-making, provide patients with critical information independent of a provider, and permit the personalization of content regarding risks and benefits. The project team consists of a multidisciplinary team skilled the development of ECA, clinical research, and decision making among men with prostate cancer.
For Aim 1 we will use a process of user-centered design with focus groups and iterative usability testing to develop a easy-to-use and well-accepted technology across literacy levels.
For Aim 2 we will conduct a pilot clinical trial t test the hypothesis that the software can reduce decisional conflict among men with prostate cancer, a widely used outcome in the study of decision aids. Through this proposal we aim to meet the urgent need for patient-centered care for men with prostate cancer. Demonstration of clinical benefit will set the stage for future studies investigating the effect on important subgroups of patients such as those with limited health literacy and to study the integration of such a tool into clinical workflow. Ultimately we envision a tool that could be generalized to a number of other conditions and could transform the process of shared decision making for millions of patients.

Public Health Relevance

The failure to deliver patient-centered care to men with prostate cancer threatens patient autonomy, places patient safety at risk, and contributes to costly and unnecessary treatments. This proposal seeks to develop and evaluate an innovative technology that is designed to help men with low health literacy make informed decisions about prostate cancer treatment.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Health Care Technology and Decision Science (HTDS)
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Bernstein, Steve
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Emory University
Internal Medicine/Medicine
Schools of Medicine
United States
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