Our team of decision scientists develops simulations that enable decision-makers to understand the influence of new system designs; elicit patient preferences using discrete choice experiments and other procedures to understand what really matters most to patients, and develop interactive decision aids that help clinicians to make informed shared decisions with their patients.
Decision science studies how people make choices and how they can make better choices using current knowledge, recognizing the presence of uncertainty, complexity, and competing values and trade-offs.
This contrasts with most fields of health research, which focus on producing new knowledge through better evidence and new treatments and technologies. Many methods of decision science have been developed in other disciplines, such as business, transportation, and the military, but many of these techniques have yet to be fully exploited in health care.
Our team of decision scientists develop simulations that enable decision-makers to understand the influence of new system designs; elicit patient preferences using discrete choice experiments and other procedures to understand what really matters most to patients; develop decision aids that help clinicians to make informed, shared decisions with their patients and conduct network meta-analyses to inform decisions using the best available evidence.
Dr. Nick Bansback is a Canadian Institutes of Health Research New Investigator whose research aims to inform policies and practices in health through the application of health economics and decision theory.
The Decision Sciences Program at CHÉOS aims to understand and inform decision making by patients, clinicians, and policy makers.
Summary: This research seeks to understand the barriers and facilitators to implementation of mifepristone in Canada and involves the development of tools to support clinical decision making – decision support checklists for health care professionals and a patient decision aid for people seeking to understand options for management of unplanned pregnancy. Dr. Munro is co-investigator on this research led by Dr. Wendy V. Norman (UBC) and funded in part by the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, and a grant from the Society of Family Planning. They are currently testing an online interactive patient decision aid in partnership with researchers from Dalhousie University.
Summary: There are hundreds of patient decision aids available worldwide, but the rapid growth of this field has led to the need for clear standards and criteria. Is a particular decision aid a reliable source of health information? Is it effective in supporting decision making? Dr. Munro, along with members of the Decision Sciences team, collaborate with the International Patient Decision Aid Standards (IPDAS) Collaboration. This group of researchers, clinicians, and stakeholders has developed standards for the development and evaluation of patient decision aids. A special issue with updated standards will be published Medical Decision Making in 2021. Dr. Munro and colleagues have co-authored updates on patient narratives and implementation of patient decision aids in routine care. These publications provide evidence-based guidance for clinicians and decision aid developers on how to put shared decision-making into practice. The Decision Sciences Program has also been heavily involved in the annual Society for Medical Decision Making conference, with Dr. Bansback hosting the meeting in 2017 and Dr. Munro hosting in 2022.
Birth after Caesarean: An Investigation of Factors that Influence Choice of Mode of Delivery
CHÉOS Lead: Sarah Munro
Summary: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. Based on findings from a mixed methods program of research and integrated knowledge translation, we have developed an interactive website to support decision-making for mode of birth after caesarean section in British Columbia. The KT tool is part of a multi-faceted shared decision-making intervention that is being co-developed with the BC Ministry of Health, Perinatal Services BC, regional health authorities, and experts at the Preference Laboratory at Dartmouth College. We have also conducted implementation science surveys to understand the contextual factors that support uptake of shared decision making in routine care.
Navigating Sexual and Reproductive Health Care in BC: Unmet Needs of Migrant Youth
CHEOS Lead: Sarah Munro, with trainee Zeba Khan and Options for Sexual Health
Summary: Im/migrant populations, particularly youth, experience higher rates of unmet sexual and reproductive health needs. In the absence of culturally appropriate and accessible sexual and reproductive health care, they may face an increased risk of harm when engaging in normal, healthy sexual behaviours for their age. Dr. Munro and trainee Zeba Khan hope to describe and analyze the individual, sociocultural, economic and immigration specific factors that influence the access of sexual and reproductive health among im/migrant youth. The project involves interviews guided by KT and user-centred design principles. Understanding the specific needs of the im/migrant youth will allow them to develop KT strategies to address these gaps, including mHealth decision support tools. This work is funded by a grant from the Vancouver Foundation and is conducted in collaboration with Options for Sexual Health and researchers at the University of Alberta.
Shared Decision Making and Infant Feeding: Literature Review and Expert Engagement
CHÉOS Lead: Sarah Munro
Summary: Currently, BC does not have provincial, evidence-informed practice support resources or KT tools to help health care professionals to engage with families in order to support them to make quality decisions about their infant feeding options (such as breastfeeding or supplementing with formula) in a non-stigmatizing/non-judgmental manner. In partnership with the Ministry of Health and the BCCDC, our aim was to develop a suite of evidence-informed practice support resources. Our objectives were (i) To conduct a literature review to understand decision-making behaviours, needs, challenges, and opportunities for infant feeding choices faced by patient populations when they are making infant feeding choices prenatally, during antepartum admission, and postpartum; (ii) To engage with health care professionals through key informant interviews and focus groups to understand their practice support needs and create a KT strategy for putting resources into practice to improve patient care.
Where and How You Birth (WHY Birth): Development of a Patient Decision Aid for Model of Care and Place of Birth
CHÉOS Lead: Sarah Munro
Summary: Shared decision making is a form of patient-oriented knowledge translation. It involves the exchange of best evidence and patient values to ensure that families make health care decisions that reflect their informed preferences. Patient decision aids are knowledge translation tools to support the shared decision making process. We developed an online interactive patient decision aid to support women and health care providers when making decisions about model of care and place of birth. This work was conducted in partnership with Prof. Saraswathi Vedam and the Birthplace Lab in the UBC Department of Family Practice, and was funded by the Vancouver Coastal Health Research Institute.
Right For Me: A Cluster Randomised Trial of Two Interventions for Facilitating Shared Decision-Making About Contraceptive Methods
CHÉOS Lead: Sarah Munro
Summary: In the United States, over half of all pregnancies are unintended. Unintended pregnancy often occurs because women do not have a contraceptive method that fits their needs and lifestyle. The purpose of this implementation science research was to learn the best way to support women and their providers as they together compare contraceptive methods and choose a method based on what matters most to the woman. The Right for Me study was a large multi-centre randomized control trial in the eastern US that aimed to improve shared conversations about birth control methods between patients and providers. It was led by Dr. Rachel Thompson at Dartmouth College, involved patients as partners in all stages of the research process, and was funded by the Patient-Centered Outcomes Research Institute. Dr. Munro conducted the qualitative evaluation of the implementation of the shared decision-making interventions, informed by the Theoretical Domains Framework. The evaluation explored how clinics implemented the shared decision-making interventions. This evidence will help policy makers and researchers understand what strategies are best for implementing shared decision-making into routine care.
Want to learn more about our Decision Sciences Program? Read related stories below.
CHÉOS Scientist Dr. Sarah Munro investigated what factors influence shared decision-making between care providers and parents-to-be who have previously undergone a C-section
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New research led by CHÉOS Trainee Rebecca Metcalfe shows that women have diverse needs for shared decision making in pregnancy
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