In the winter of 2017, I was given the opportunity to, briefly, be a part of the research team for a study we refer to as the "What Matters Most" study (Durand, et al., 2021). While I was simply a student researcher asked to input data and write short summaries of findings, the study itself investigates an incredibly important ethical and medical issue today.
As many of the MSBS students know, thanks to our seminar discussion a few days regarding the impacts of an individual's social and economic standing on their health, socioeconomic standing has a huge impact on health. Breast cancer and treatment decisions are no exception to this understanding. The question is, how do we empower patients to overcome the socioeconomic barriers that healthcare introduces?
The What Matters Most Study attempted to address this. The study recognized that socioeconomic status, regardless of race, is a significant indicator of poorer outcomes and poorer treatment received among women with early-stage breast cancer. (Bradley & Roberts, 2002). Among women of lower socioeconomic status, the majority report poorer communication with medical professionals, less knowledge about possible surgeries, an increase in mastectomies, a decrease in satisfaction post surgery, and worse outcomes (Bradley & Roberts, 2002). Taking this into consideration, the What Matters Most study attempted to overcome the socioeconomic barriers in order to ensure that women with early-stage breast cancer, who were of lower socioeconomic status, could have better post-treatment outcomes (Durand, et al., 2021).
The researchers studied a total of 571 women (of varying socioeconomic status) with early stage breast cancer. The patients were split into three different groups and were then seen in one of seven different clinics. One group of participants were given a text-only conversation aid (Option Grid) which include a single sheet of paper providing a summary of available options of treatment. The second group of participants were given a four page pictorial conversation aid (Picture Option Grid) providing the same information as the Option Grid, however with pictures and simpler language. The last group of participants were presented surgery options in the "usual care" method indicating that surgeons provided their standard information regarding breast cancer treatments. The participants were then asked to fill out short questionnaires at six different times: before their first consultation, during the surgical visit, immediately after the visit, one week after surgery, twelve weeks after surgery, and a year after surgery (Durand, et al., 2021).
The researchers found that, overall, patients who were educated with the Picture Option Grid resulted in a greater knowledge after consultation, an improved decision process and a lower decision regret compared to patients who received usual care. The Option Grid resulted in an improved decision process compared to those who received usual care. Most importantly, the Picture Option Grid had a greater impact on knowledge, education and quality of life among lower socioeconomic patients. The Picture Option Grid had been created to overcome the literacy, language and education barriers that many patients of low socioeconomic status face in health care settings. Through providing pictures and easy to understand language in consultations, patients of lower socioeconomic status were able to regain autonomy in their decisions regarding surgery and surgeons were able to exercise greater beneficence through better educating their patients in a way that resulted in a greater patient reported satisfaction post surgery (Durand, et al., 2021).
While healthcare is still an incredibly far cry from overcoming socioeconomic barriers, the What Matters Most study provides a great example of and a staring point for how medical professionals can play a part in reducing disparities among disadvantaged groups and improving health care among individuals of lower socioeconomic status.
References:
Bradley, C. J., Given, C. W., & Roberts, C. (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94(7), 490–496. https://doi.org/10.1093/jnci/94.7.490
Durand, M. A., Yen, R. W., O'Malley, A. J., Schubbe, D., Politi, M. C.,
Saunders, C. H., Dhage, S., Rosenkranz, K., Margenthaler, J., Tosteson,
A., Crayton, E., Jackson, S., Bradley, A., Walling, L., Marx, C. M.,
Volk, R. J., Sepucha, K., Ozanne, E., Percac-Lima, S., Bergin, E., …
Elwyn, G. (2021). What matters most: Randomized controlled trial of
breast cancer surgery conversation aids across socioeconomic strata. Cancer, 127(3), 422–436. https://doi.org/10.1002/cncr.33248
This is SO important to talk about! I came from a very small town and grew up financially strained, so has many of my friends and family. I cannot express how many times I watched my grandmother avoid the doctors purely for financial reasons.
ReplyDeleteIt is true that many diseases are becoming a poor person illness because those who are lower socioeconomically cannot afford the same treatments that someone with money can.
Ethically this is still so challenging because not only are we facing an issue politically but socially too! I had an ex who had a family who was very wealthy could believe my dad didnt have 500$ to spend on a doctors appointment. When my father needed money for a hernia surgery he had to wait in pain until it became septic before they would treat it. whereas someone who is well off can still get a hernia, but can afford to treat it sooner and not risk further health problems. So yes the health disparity is real!
Hi Ephie,
ReplyDeleteThis is a really sad but important topic to discuss. This is the first time I learned of methods specialized for educating patients with less formal educational backgrounds. After doing some more reading into this study, I found that this type of intervention has been further researched in other conditions such as osteoporosis and Diabetes Mellitus. My initial thought after reading this was to search how many free clinics actually make use of conversational aids. While I was not able to find a systemic review discussing its use at the state or nation level, I think further investigation in it's clinical use will help gain a greater understanding of where the health care system is in increasing medical use among those of lower SES. The process for improving overall health care utilization among the different populations in the US still has a long way to go, however studies like this and their clinical implementations will be of huge benefit in decreasing the gaps found in the health care system.