A Conversation with Mary Politi about Decision Aids, Clinical Trial Disparities, and Health Insurance Enrollment

Sarah E. Lillie, PhD, Health Decision Making SIG chair

The Health Decision Making Special Interest Group (HDM SIG) recently interviewed Mary Politi, PhD, a clinical psychologist and an associate professor in the Division of Public Health Sciences, Department of Surgery, at Washington University in St. Louis. Dr. Politi’s research program focuses on helping patients and clinicians work through the uncertainties of health decisions through developing and evaluating decision tools, examining techniques to aid clinical discussions about health decisions, and exploring ways to improve communication about risks.

HDM SIG members will be interested to learn about Dr. Politi’s most recent research involving clinical trial participation and health insurance options. For those new to decision aids and health decision making, Dr. Politi shares insight as a leader in her field.

Dr. Politi’s responses are summarized below.

HDM: As a clinical psychologist, how did you develop your interest in decision aids?

Politi: “I became interested in shared decision making and decision support through working with patients who struggled to make sense of the information conveyed to them about their health. Most were faced with choices and few knew how to navigate through the vast amount of information available on the Internet, from their social networks, and from their health care providers.”

HDM: You recently completed a randomized trial of a decision aid to support cancer clinical trial participation. How does this effort reduce disparities in cancer clinical trials?

Politi: “Some individuals have misconceptions and fears about clinical trials based on historical mistreatment of individuals in trials, many from minority or medically underserved communities. For example, some people mistakenly assume that cancer clinical trials might offer them a sugar pill or placebo rather than needed cancer treatments. Providing accurate, evidence-based information and allowing patients to think about whether a clinical trial is right for them through a decision aid can help patients consider trial participation without the pressure of a health care provider (sometimes a trial Principal Investigator) anxiously awaiting an answer. Some patients might want more information from a provider after they learn more about trials, but many need time to learn about the purpose and function of clinical trials.”

HDM: How did you decide to focus your recent work on health insurance decisions?

Politi: “Most of us, even those who have had insurance for years, struggle to figure out the best health insurance plan for ourselves or our families. It is difficult to weigh trade-offs between cost and coverage with so many unknowns about future health care utilization. In addition, the health insurance marketplace through the ACA offers a large number of private insurance options (in our region, for example, people have a choice of 46 different plans). Going through each one can lead to choice overload. Many default to what appears to be a reasonable option without really knowing whether there is a better fit plan for them. Decision aids with cost calculators, plain language explanations, and preference sorting features can help model what plan(s) might work best for an individual’s health and financial needs.”

HDM SIG: How do you see decision aids moving forward, in design and in implementation?

Politi: “The field has proposed minimum standards in decision aid design that provide a useful guide for those new to developing such tools. Some states and individual institutions have adopted policies to support wide-scale use of decision aid implementation. My hope is that these policy changes at institutions and government levels spread to help support practitioners who value decision aids but require additional resources to access them and use them in routine practice.”

For those interested in learning more about decision aids and about Dr. Politi’s work, the HDM SIG has proposed a midday meeting entitled Decision Aids to Improve Care: An Overview and Examples of Web-Based Patient Decision Aids for the 2017 Annual Meeting. As part of this session, Dr. Politi will describe her decision aid to improve currently uninsured individuals’ decision making about health insurance as they prepare to enroll in the Affordable Care Act health insurance exchanges. We hope to see you there!