Empowering Informed Patient Decisions and Reducing Financial Burden of Care

Summary

Health information is complicated. Often, health care teams communicate important health information in complex ways.¹ As a result, patients may not always understand their health conditions or treatment options and thus cannot make truly informed decisions about their care. There is room for improvement in health communication in both clinical and community settings. This gap highlights the need to develop strategies that foster effective communication between health care teams and patients, as well as decision-making interventions to empower patients to engage in their own care. One way to address this gap is by embedding shared decision-making into clinical workflows. Shared decision-making means that the patient and the healthcare team come together to reach a treatment decision. Shared decision-making combines high-quality clinical evidence with patients’ personal values and preferences.^2–4 When healthcare teams engage patients in care decisions and communicate health information in clear and understandable ways, patients better understand treatment decisions, are more likely to adhere to treatment regimens, and see improved outcomes.^5,6

Dr. Mary Politi’s team at Washington University in St. Louis designs evidence-based decision aids to help patients understand their health care options and make informed choices about their care. They also train clinicians to use these tools and work with health systems to incorporate these tools into routine practice. Dr. Politi and her team include cost and insurance information in their interventions, which helps patients learn about their costs across insurance plans, anticipate out-of-pocket expenses, and choose affordable, high-quality care. Including costs ensures that health decisions are actionable and aligned with patients’ needs. Dr. Politi’s team partners with patients, patient advocates, community members, clinicians, and informatics experts to ensure that research and clinical interventions meet the needs of all.

Below we have provided four examples of research projects that provide an overview of ongoing work. These projects’ benefits are included in the benefits table. For more information about Dr. Politi’s past and current collaborative projects, please visit: https://collaborativecare.wustl.edu/example-projects.  

• BREASTChoice is an interactive decision support tool designed to help women who are considering a mastectomy. This tool helps women learn about their personal risk of complications, decide whether or not to have breast reconstruction, and consider which breast reconstruction option is best for them.^7-9
• Patient, Caregiver, and Clinician Perceptions of Guidelines about Antibiotic Stewardship for Asymptomatic Bacteriuria is a series of projects aimed to reduce over-prescribing of antibiotics for bacteria in the urine without symptoms (ASB) in older adults. This may contribute to antibiotic resistance, which is a serious public health threat.^10-12
• Improving Cancer Patients’ Insurance Choice (I Can PIC) is a health insurance decision support tool to help patients and survivors of cancer. With the tool, patients and survivors can understand insurance terms and options, consider care costs, talk to clinicians about financial needs, and identify financial resources or insurance to help offset care costs.¹³
• Project SCORE (Streamlined Consents for Research) is a multi-site trial to adapt, implement, and test clear, engaging informed consent templates for research studies.^14,15

Significance

Dr. Politi’s team focuses on these main processes: 

• Improving decision communication so patients can understand risks, benefits, and costs of options. 
• Centering patient priorities to ensure decisions reflect what matters most to them. 
• Reducing economic burden of care through insurance‐choice support and cost-saving strategies. 

Together, these efforts advance equitable, patient-centered care and can be scaled across clinical and community settings.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Clinical & medical benefits

Co-created BREASTChoice, an interactive decision support tool, with patients, clinicians, informatics experts, risk prediction modelers, and community partners.  demonstrated.

Patient-guided research (new TSBM Benefit)

Co-created Improving Cancer Patients’ Insurance Choice (I Can PIC) with survivors of cancer, clinicians, decision scientists, health economists, and insurance experts. demonstrated.

Patient-guided research (new TSBM Benefit)

Co-created Patient, Caregiver and Clinician Perceptions of Guidelines about Antibiotic Stewardship for Asymptomatic Bacteriuria materials with patients, caregivers, and clinicians. demonstrated.

Patient-guided research (new TSBM Benefit)

Improved shared decision-making, enhanced decision quality, and reduced high-risk choices by increasing patient understanding of personal risk and aligning care with patient values. (BREASTChoice) demonstrated.

Shared decision-making (new TSBM Benefit)

Strengthen clinical encounters by embedding cost and value discussions. (Improving Cancer Patients’ Insurance Choice [I Can PIC])  potential.

Shared decision-making (new TSBM Benefit)

Community & public health benefits

Developed a web-based tool accessible via browser on any device, designed for at-home use independent of clinic visits. (BREASTChoice, Improving Cancer Patients’ Insurance Choice [I Can PIC])  demonstrated.

Consumer software

Developed a brochure to support patient and caregiver education about using antibiotics responsibly. (Patient, Caregiver and Clinician Perceptions of Guidelines about Antibiotic Stewardship for Asymptomatic Bacteriuria)  demonstrated.

Health education resources

Improved patient knowledge with BREASTChoice, a tailored web tool that delivers personalized education before surgical consults.  demonstrated.

Health education resources

Provided patient and caregiver education about responsibly using antibiotics through Patient, Caregiver, and Clinician Perceptions of Guidelines about Antibiotic Stewardship for Asymptomatic Bacteriuria materials. demonstrated.

Health education resources

Improved workflow by embedding the BREASTChoice tool into Electronic Health Records so surgeons see a one‑page summary of patients’ personalized risk and preferences. (BREASTChoice)  demonstrated.

Health care delivery

Increased patient knowledge and aligned high-risk patients toward safer choices, thus enhancing decision quality and potentially reducing postoperative complications. (BREASTChoice)  demonstrated.

Health care quality

Improve delivery of guideline-based care by reducing unnecessary antibiotic prescribing for asymptomatic bacteriuria through tailored education for clinicians, patients, and caregivers.  potential.

Health care delivery

Improve participants’ ability to make informed choices, reducing confusion, potential ethical missteps, and enhancing the overall quality of the consent process. (Project SCORE [Streamlined Consents for Research])  potential.

Health care quality

Reduce over-prescribing of antibiotics for asymptomatic bacteriuria (ASB) in older adults to help prevent antibiotic resistance, a serious public health threat. (Patient, Caregiver and Clinician Perceptions of Guidelines about Antibiotic Stewardship for Asymptomatic Bacteriuria)  potential.

Health care quality

Promote disease prevention by developing educational tools that empower clinicians, patients, and caregivers to reduce unnecessary antibiotic use for asymptomatic bacteriuria and prevent antibiotic resistance.  potential.

Disease prevention & reduction

Economic benefits

Guide patients toward insurance plans that help them pay for care needs, thus reducing out-of-pocket spending. (Improving Cancer Patients’ Insurance Choice [I Can PIC])  potential.

Cost savings

Lessen downstream costs by preventing people from delaying or avoiding needed care due to costs. (Improving Cancer Patients’ Insurance Choice [I Can PIC])  potential.

Societal & financial cost of illness

Policy & legislative benefits

Inform best practice guidelines on the federal requirement for the key information section of informed consent using plain language, health literacy, and visual design principles. (Project SCORE [Streamlined Consents for Research])  potential.

Standards

Develop a standardized template with icon library, resources, and instructional videos to standardize the format of consents. (Project SCORE [Streamlined Consents for Research])  potential.

Standards

This research has clinical, community, economic, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.¹⁶

Clinical

BREASTChoice is an interactive decision support tool designed to help women facing mastectomy make informed choices about breast reconstruction. By presenting personalized risk assessments and clear, comprehensive information, the tool supports patients in understanding their options, aligning treatment with their values, and reducing the likelihood of high-risk decisions or post-treatment regret. 

Co-developed with input from patients, surgeons, and other stakeholders, BREASTChoice reflects the diverse needs of women considering reconstruction. Its user-friendly design integrates seamlessly into clinical workflows and electronic health records, ensuring accessibility for both patients and providers during consultations. 

Through strategic dissemination and health IT integration, BREASTChoice delivers timely, personalized support at critical decision points. It strengthens shared decision-making, enhances patient engagement, and improves care delivery, ultimately advancing patient-centered, high-quality surgical care. 

Community

Patient, Caregiver, and Clinician Perceptions of Guidelines about Antibiotic Stewardship for Asymptomatic Bacteriuria is a multi-project initiative working to reduce the overuse of antibiotics for asymptomatic bacteriuria (ASB) in older adults—a condition that typically does not require treatment. Despite this, antibiotics are often unnecessarily prescribed, contributing to antibiotic resistance, a growing public health threat. 

The initiative engages older adults, caregivers, and clinicians—groups that often face barriers to trustworthy, culturally relevant health information. It supports informed decision-making, reduces patient risk from unnecessary antibiotic use, and equips clinicians with tools to provide evidence-based care aligned with patient and family concerns. 

Active across hospitals, nursing homes, community clinics, and outreach programs, the initiative emphasizes the connection between individual care and population health. Through education, guideline development, and culturally responsive communication, it advances antibiotic stewardship and improves outcomes for vulnerable populations. 

Economic

The Improving Cancer Patients’ Insurance Choice (I Can PIC) tool is a decision support resource designed to help individuals with cancer make informed health insurance choices. It enhances insurance literacy by helping users understand coverage options, compare estimated care costs across plans, discuss financial concerns with clinicians, and identify financial assistance resources. By offering real-time, personalized cost estimates, I Can PIC supports cost transparency and promotes informed decision-making. The tool also engages key champions—such as social workers, financial navigators, and lay health educators—to facilitate cost conversations, ultimately improving patient outcomes and supporting long-term financial well-being. 

Policy

Project SCORE (Streamlined Consents for Research) is a multi-site trial focused on improving informed consent processes by developing, implementing, and evaluating clear, engaging consent templates for research studies. The project aims to enhance participant understanding and streamline consent across diverse research settings. 

By involving key end-users—including investigators, research staff, IRB members, institutional leaders, and community partners—Project SCORE ensures that consent practices are practical, ethical, and responsive to community needs. 

Findings from the study have informed national guideline committees and institutional policies, supporting the broader adoption of best practices for human subjects research. Through stakeholder engagement and evidence-based tools, Project SCORE promotes more transparent, inclusive, and effective research communication. 

Lessons Learned

• Engage patients, their families, healthcare teams, and hospital experts in all stages of the project. Those who will use the intervention should be involved as partners throughout the entire process.
• Identify the people and steps required to implement interventions into routine care. Often, there are more people involved in this process than originally thought.
• Actively look for institutional policies and procedures that could block intervention implementation, and work with local leaders to overcome these barriers.
• Plan for studies and implementation processes to take longer than expected, especially if local and specific changes are needed at different sites and settings.