Bio


I am a medical anthropologist with a background in public health and a passion for research that engages the voices of patients and families in improving population health and healthcare delivery. I am a proud Midwesterner, with a B.A. in anthropology from the University of Wisconsin-Madison, and a PhD and MPH from Case Western Reserve University in Cleveland, Ohio. My broad research interests include the psychosocial dimensions of health and illness, the well-being of children and families, and medical decision-making, particularly in the context of complex illness. I also am a perpetual student of the art of grant writing, and I love supporting scientists in developing this critical skill. At the Center for Biomedical Ethics, my research examines the ethical and economic implications of genome sequencing for diagnosis of children with rare diseases and their families. My work examines the ethical implications of varying approaches to economic evaluation and their relation to reimbursement and equitable access to new genomic technologies. I am also interested in the development of new tools for measurement of the costs and benefits of new genomic technologies that reflect patient values.

Institute Affiliations


  • Member, Maternal & Child Health Research Institute (MCHRI)

All Publications


  • Barriers and Facilitators to Real-world Implementation of the Diabetes Prevention Program in Large Healthcare Systems: Lifestyle Coach Perspectives. Journal of general internal medicine Halley, M. C., Petersen, J., Nasrallah, C., Szwerinski, N., Romanelli, R., Azar, K. M. 2020

    Abstract

    BACKGROUND: Group-based lifestyle change programs based on the Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful real-world implementation. Studies have examined implementation in community settings, but less is known about integration in healthcare systems, and particularly in large, multi-site systems with the potential for extended reach.OBJECTIVE: To examine the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system.DESIGN: Semi-structured interviews, based on the RE-AIM framework, were conducted in person for 30-90min each.PARTICIPANTS: Past and present DPP lifestyle coaches in the healthcare system identified using purposive sampling.APPROACH: Thematic analysis of qualitative data to identify key factors influencing the success of DPP implementation. An iterative consensus process was used to model the relationships among factors.KEY RESULTS: We conducted 33 interviews across 20 clinic sites serving 12 counties. Participants described six key factors as potential barriers or facilitators to implementation, including (1) Broader Context, including the surrounding physical and sociodemographic context; (2) Institutional Context, including finances, infrastructure, and personnel; (3) Program Provision, including curriculum, administration, cost, goals, and visibility; (4) Recruitment Process, including screening and referrals; (5) Lifestyle Coaches, including their characteristics, behaviors, and morale; and (6) Cohort, including group attrition/retention and interpersonal dynamics. These factors were both highly interconnected in their impact on implementation and widely variable across sites within the healthcare system, as illustrated in our multi-level conceptual framework.CONCLUSIONS: This study identified key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches. With further examination, the conceptual model presented here may be used for planning and managing the implementation of group-based behavioral interventions in these settings.

    View details for DOI 10.1007/s11606-020-05744-y

    View details for PubMedID 32291720

  • Differing views regarding diet and physical activity: adolescents versus parents' perspectives. BMC pediatrics Azar, K. M., Halley, M., Lv, N., Wulfovich, S., Gillespie, K., Liang, L., Goldman Rosas, L. 2020; 20 (1): 137

    Abstract

    BACKGROUND: Today, approximately one in five United States adolescents age 12 to 19years is obese and just over a third are either overweight or obese. This study examines how parents and peers influence diet and physical activity behaviors of older adolescents (14-18years) with overweight or obesity to inform weight management interventions.METHODS: Adolescent participants included 14 to 18-year-olds with a Body Mass Index (BMI) greater than the 85th percentile for their age and sex who were receiving care in a large healthcare system in Northern California. Adolescents and their parents participated in separate focus groups and interviews (if not able to attend focus groups) that were held at the same time in the same location. We used qualitative thematic analysis to identify common themes discussed in the adolescent and parent focus groups as well as paired analysis of adolescent-parent dyads.RESULTS: Participants included 26 adolescents and 27 parents. Adolescent participants were 14 to 18years old. Half were female and the participants were almost evenly distributed across year in school. The majority self-identified as White (56%) and Asian (36%).Three themes were identified which included 1) parents overestimated how supportive they were compared to adolescents' perception 2) parents and adolescents had different views regarding parental influence on adolescent diet and physical activity behaviors 3) parents and adolescents held similar views on peers' influential role on lifestyle behaviors.CONCLUSION: Parents' and adolescents' differing views suggest that alignment of parent and adolescent expectations and behaviors for supporting effective weight management could be incorporated into interventions.

    View details for DOI 10.1186/s12887-020-02038-4

    View details for PubMedID 32220230

  • Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review. BMJ (Clinical research ed.) Adekunle, L., Chen, R., Morrison, L., Halley, M., Eng, V., Hendlin, Y., Wehner, M. R., Chren, M., Linos, E. 2020; 368: m7

    Abstract

    OBJECTIVE: To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature.DESIGN: Systematic review.DATA SOURCES: PubMed, Embase, and Web of Science, up to 15 February 2019.STUDY SELECTION CRITERIA: Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded.RESULTS: 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4).CONCLUSIONS: Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019123617.

    View details for DOI 10.1136/bmj.m7

    View details for PubMedID 32019742

  • Development of a patient decision aid for the management of superficial basal cell carcinoma (BCC) in adults with a limited life expectancy. BMC medical informatics and decision making Junn, A., Shukla, N. R., Morrison, L., Halley, M., Chren, M. M., Walter, L. C., Frosch, D. L., Matlock, D., Torres, J. S., Linos, E. 2020; 20 (1): 81

    Abstract

    Basal cell carcinoma (BCC) is a slow-growing, rarely lethal skin cancer that affects people 65 years or older. A range of treatment options exist for BCC, but there is little evidence available to guide patients and providers in selecting the best treatment options.This study outlines the development of a patient decision aid (PDA) for low-risk BCC that can be used by patients and providers to assist in shared decision-making.In accordance with the International Patient Decision Aids Standards (IPDAS) Collaboration framework, feedback from focus groups and semi-structured interviews with patients and providers, an initial prototype of the PDA was developed. This was tested using cognitive interviews and iteratively updated.We created eighteen different iterations using feedback from 24 patients and 34 providers. The key issues identified included: 1) Addressing fear of cancer; 2) Communicating risk and uncertainty; 3) Values clarification; and 4) Time lag to benefit.The PDA does not include all possible treatment options and is currently paper based.Our PDA has been specifically adapted and designed to support patients with a limited life expectancy in making decisions about their low risk BCC together with their doctors.

    View details for DOI 10.1186/s12911-020-1081-8

    View details for PubMedID 32349762

  • Supporting caregivers during hematopoietic cell transplantation for children with primary immunodeficiency disorders JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY Yoo, J., Halley, M. C., Lown, E., Yank, V., Ort, K., Cowan, M. J., Dorsey, M. J., Smith, H., Lyengar, S., Scalchunes, C., Mangurian, C. 2019; 143 (6): 2271–78

    Abstract

    Caregivers of children with primary immunodeficiency disorders (PIDs) experience significant psychological distress during their child's hematopoietic cell transplantation (HCT) process.This study aims to understand caregiver challenges and identify areas for health care system-level improvements to enhance caregiver well-being.In this mixed-methods study caregivers of children with PIDs were contacted in August to November 2017 through online and electronic mailing lists of rare disease consortiums and foundations. Caregivers were invited to participate in an online survey assessing sociodemographic variables, the child's medical characteristics, psychosocial support use, and the World Health Organization-5 Well-Being Index. Open-ended questions about health care system improvements were included. Descriptive statistics and linear multivariate regression analyses were conducted. A modified content analysis method was used to code responses and identify emergent themes.Among the 80 caregiver respondents, caregivers had a median age of 34 years (range, 23-62 years) and were predominantly female, white, and married with male children given a diagnosis of severe combined immune deficiency. In the adjusted regression model lower caregiver well-being was significantly associated with lower household income and medical complications. Challenges during HCT include maintaining relationships with partners and the child's healthy sibling or siblings, managing self-care, and coping with feelings of uncertainty. Caregivers suggested several organizational-level solutions to enhance psychosocial support, including respite services, online connections to other PID caregivers, and bedside mental health services.Certain high-risk subpopulations of caregivers might need more targeted psychosocial support to reduce the long-term effect of the HCT experience on their well-being. Caregivers suggested several organizational-level solutions for provision of this support.

    View details for DOI 10.1016/j.jaci.2018.10.017

    View details for Web of Science ID 000470113200030

    View details for PubMedID 31178019

    View details for PubMedCentralID PMC6559373

  • Implementation of a group-based diabetes prevention program within a healthcare delivery system. BMC health services research Azar, K. M., Nasrallah, C., Szwerinski, N. K., Petersen, J. J., Halley, M. C., Greenwood, D., Romanelli, R. J. 2019; 19 (1): 694

    Abstract

    Group-based Diabetes Prevention Programs (DPP), aligned with recommendations from the Centers for Disease Control and Prevention, promote clinically significant weight loss and reduce cardio-metabolic risks. Studies have examined implementation of the DPP in community settings, but less is known about its integration in healthcare systems. In 2010, a group-based DPP known as the Group Lifestyle Balance (GLB) was implemented within a large healthcare delivery system in Northern California, across three geographically distinct regional administration divisions of the organization within 12 state counties, with varying underlying socio-demographics. The regional divisions implemented the program independently, allowing for natural variation in its real-world integration. We leveraged this natural experiment to qualitatively assess the implementation of a DPP in this healthcare system and, especially, its fidelity to the original GLB curriculum and potential heterogeneity in implementation across clinics and regional divisions.Using purposive sampling, we conducted semi-structured interviews with DPP lifestyle coaches. Data were analyzed using mixed-method techniques, guided by an implementation outcomes framework consisting of eight constructs: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability.We conducted 33 interviews at 20 clinics across the three regional administrative divisions. Consistencies in implementation of the program were found across regions in terms of satisfaction with the evidence base (acceptability), referral methods (adoption), eligibility criteria (fidelity), and strategies to increase retention and effectiveness (sustainability). Heterogeneity in implementation across regions were found in all categories, including: the number and frequency of sessions (fidelity); program branding (adoption); lifestyle coach training (adoption), and patient-facing cost (cost). Lifestyle coaches expressed differing attitudes about curriculum content (acceptability) and suitability of educational level (appropriateness). While difficulties with recruitment were common across regions (feasibility), strategies used to address these challenges differed (sustainability).Variation exists in the implementation of the DPP within a large multi-site healthcare system, revealing a dynamic and important tension between retaining fidelity to the original program and tailoring the program to meet the local needs. Moreover, certain challenges across sites may represent opportunities for considering alternative implementation to anticipate these barriers. Further research is needed to explore how differences in implementation domains impact program effectiveness.

    View details for DOI 10.1186/s12913-019-4569-0

    View details for PubMedID 31615525

    View details for PubMedCentralID PMC6792249

  • Motivations among sexual-minority men for starting and stopping indoor tanning. The British journal of dermatology Admassu, N., Pimentel, M. A., Halley, M. C., Torres, J., Pascua, N., Katz, K. A., Linos, E. 2019; 180 (6): 1529–30

    View details for DOI 10.1111/bjd.17684

    View details for PubMedID 30671929

    View details for PubMedCentralID PMC6615883

  • Identifying barriers to care and research in hidradenitis suppurativa: findings from a patient engagement event. The British journal of dermatology Shukla, N., Paul, M., Halley, M., Lowes, M. A., Hester, V., Aguilar, C., Guilbault, S., Long, T. S., Taylor, A., Thompson, A. C., Yannuzzi, C. A., Linos, E., Naik, H. B. 2019

    View details for DOI 10.1111/bjd.18818

    View details for PubMedID 31883104

  • Beyond exploratory: a tailored framework for designing and assessing qualitative health research. BMJ open Rendle, K. A., Abramson, C. M., Garrett, S. B., Halley, M. C., Dohan, D. 2019; 9 (8): e030123

    Abstract

    The objective of this commentary is to develop a framework for assessing the rigour of qualitative approaches that identifies and distinguishes between the diverse objectives of qualitative health research, guided by a narrative review of the published literature on qualitative guidelines and standards from peer-reviewed journals and national funding organisations that support health services research, patient-centered outcomes research and other applied health research fields. In this framework, we identify and distinguish three objectives of qualitative studies in applied health research: exploratory, descriptive and comparative. For each objective, we propose methodological standards that may be used to assess and improve rigour across all study phases-from design to reporting. Similar to hierarchies of quality of evidence within quantitative studies, we argue that standards for qualitative rigour differ, appropriately, for studies with different objectives and should be evaluated as such. Distinguishing between different objectives of qualitative health research improves the ability to appreciate variation in qualitative studies and to develop appropriate evaluations of the rigour and success of qualitative studies in meeting their stated objectives. Researchers, funders and journal editors should consider how further developing and adopting the framework for assessing qualitative rigour outlined here may advance the rigour and potential impact of this important mode of inquiry.

    View details for DOI 10.1136/bmjopen-2019-030123

    View details for PubMedID 31462482

    View details for PubMedCentralID PMC6720470

  • Physician mothers' experience of workplace discrimination: a qualitative analysis BMJ-BRITISH MEDICAL JOURNAL Halley, M. C., Rustagi, A. S., Torres, J. S., Linos, E., Plaut, V., Mangurian, C., Choo, E., Linos, E. 2018; 363: k4926

    Abstract

    To report woman physicians' experiences, in their own words, of discrimination based on their role as a mother.Qualitative analysis of physician mothers' free-text responses to the open question: "We want to hear your story and experience. Please share" included in questions about workplace discrimination. Three analysts iteratively formulated a structured codebook, then applied codes after inter-coder reliability scores indicated high concordance. The relationships among themes and sub-themes were organized into a conceptual model illustrated by exemplary quotes.Respondents to an anonymous, voluntary online survey about the health and wellbeing of physician mothers posted on a Facebook group, the Physician Moms Group, an online community of US physicians who identify as mothers.We analyzed 947 free-text responses. Participants provide diverse and vivid descriptions of experiences of maternal discrimination. Gendered job expectations, financial inequalities (including lower pay than equally qualified colleagues and more unpaid work), limited opportunities for advancement, lack of support during the pregnancy and postpartum period, and challenging work-life balance are some of the key themes identified. In addition, participants' quotes show several potential structural drivers of maternal discrimination and describe the downstream consequences of maternal discrimination on the physician herself, her career, family, and the healthcare system.These findings provide a view of maternal discrimination directly from the perspective of those who experience it. Women physicians report a range of previously uncharacterized ways in which they experience maternal discrimination. While certain aspects of these experiences are consistent with those reported by women across other professions, there are unique aspects of medical training and the medical profession that perpetuate maternal discrimination.

    View details for PubMedID 30541926

  • Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research AMERICAN JOURNAL OF BIOETHICS Kraft, S. A., Cho, M. K., Gillespie, K., Halley, M., Varsava, N., Ormond, K. E., Luft, H. S., Wilfond, B. S., Lee, S. 2018; 18 (4): 3–20
  • Collecting Practice-level Data in a Changing Physician Office-based Ambulatory Care Environment: A Pilot Study Examining the Physician induction interview Component of the National Ambulatory Medical Care Survey. Vital and health statistics. Series 2, Data evaluation and methods research Halley, M. C., Rendle, K. A., Gugerty, B., Lau, D. T., Luft, H. S., Gillespie, K. A. 2017: 1–18

    Abstract

    Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate. Using standard protocols, three field representatives conducted NAMCS physician induction interviews (PIIs) while trained ethnographers observed and audio recorded the interviews. Transcripts and field notes were analyzed to identify recurrent issues in the data collection process. Results The majority of the NAMCS items appeared to have been easily answered by the physician respondents. Among the items that appeared to be difficult to answer, three themes emerged: (a) physician respondents demonstrated an inconsistent understanding of "location" in responding to questions; (b) lack of familiarity with administrative matters made certain questions difficult for physicians to answer; and (c) certain primary care‑oriented questions were not relevant to specialty care providers. Conclusions Some PII survey questions were challenging for physicians in a multispecialty practice setting. Improving the design and administration of NAMCS data collection is part of NCHS' continuous quality improvement process.

    View details for PubMedID 29148968

  • Mapping the Decision-Making Process for Adjuvant Endocrine Therapy for Breast Cancer: The Role of Decisional Resolve MEDICAL DECISION MAKING Beryl, L. L., Rendle, K. S., Halley, M. C., Gillespie, K. A., May, S. G., Glover, J., Yu, P., Chattopadhyay, R., Frosch, D. L. 2017; 37 (1): 79–90

    Abstract

    Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor-positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant.We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time.A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs-decisional phase, decisional direction, and decisional resolve-which were then organized using a visual matrix and examined for patterns characterizing the decision-making process.Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy.Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence.

    View details for DOI 10.1177/0272989X16640488

    View details for Web of Science ID 000389609900011

    View details for PubMedID 27053528

  • The Importance Of Integrating Narrative Into Health Care Decision Making. Health affairs (Project Hope) Dohan, D., Garrett, S. B., Rendle, K. A., Halley, M., Abramson, C. 2016; 35 (4): 720–25

    Abstract

    When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice.

    View details for DOI 10.1377/hlthaff.2015.1373

    View details for PubMedID 27044974

  • An exploratory mixed-methods crossover study comparing DVD- vs. Web-based patient decision support in three conditions: The importance of patient perspectives HEALTH EXPECTATIONS Halley, M. C., Rendle, K. S., Gillespie, K. A., Stanley, K. M., Frosch, D. L. 2015; 18 (6): 2880–91

    Abstract

    The last 15 years have witnessed considerable progress in the development of decision support interventions (DESIs). However, fundamental questions about design and format of delivery remain.An exploratory, randomized mixed-method crossover study was conducted to compare a DVD- and Web-based DESI. Randomized participants used either the Web or the DVD first, followed by the alternative format. Participants completed a questionnaire to assess decision-specific knowledge at baseline and a questionnaire and structured qualitative interview after viewing each format. Tracking software was used to capture Web utilization. Transcripts were analyzed using integrated inductive and deductive approaches. Quantitative data were analyzed using exploratory bivariate and multivariate analyses.Exploratory knowledge analyses suggest that both formats increased knowledge, with limited evidence that the DVD increased knowledge more than the Web. Format preference varied across participants: 44% preferred the Web, 32% preferred the DVD and 24% preferred 'both'. Patient discussions of preferences for DESI information structure and the importance of a patients' stage of a given decision suggest these characteristics may be important factors underlying variation in utilization, format preferences and knowledge outcomes.Our results suggest that both DESI formats effectively increase knowledge. Patients' perceptions of these two formats further suggest that there may be no single 'best' format for all patients. These results have important implications for understanding why different DESI formats might be preferable to and more effective for different patients. Further research is needed to explore the relationship between these factors and DESI utilization outcomes across diverse patient populations.

    View details for DOI 10.1111/hex.12273

    View details for Web of Science ID 000368250300087

    View details for PubMedID 25263630

    View details for PubMedCentralID PMC5810733

  • Redefining Risk and Benefit: Understanding the Decision to Undergo Contralateral Prophylactic Mastectomy QUALITATIVE HEALTH RESEARCH Rendle, K. S., Halley, M. C., May, S. G., Frosch, D. L. 2015; 25 (9): 1251–59

    Abstract

    Rates of contralateral prophylactic mastectomy (CPM) among unilateral breast cancer patients are rapidly increasing; however, there are little data documenting the decision-making process of patients with no known BRCA mutations, who elect this more aggressive treatment. We conducted semistructured interviews with nine newly diagnosed patients who elected CPM over other surgical options. Using grounded theory, we analyzed interview data to identify influential decision-making factors by prevalence and intensity across participants. Decision-making factors included subjective evaluations of risk and benefit, avoidance of future breast cancer surveillance and accompanying worry, and desire to maintain (or improve) breast appearance. Based solely on survival benefit, the decision to undergo CPM might be viewed as unnecessary or even misguided. However, our findings show the importance of psychosocial factors in patients' assessments of risk and benefit, and support the need for additional patient-provider communication regarding these factors.

    View details for DOI 10.1177/1049732314557085

    View details for Web of Science ID 000359853200008

    View details for PubMedID 25371380

  • Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination. Medical decision making : an international journal of the Society for Medical Decision Making Tietbohl, C. K., Rendle, K. A., Halley, M. C., May, S. G., Lin, G. A., Frosch, D. L. 2015; 35 (8): 987–98

    Abstract

    The benefits of patient decision support interventions (DESIs) have been well documented. However, DESIs remain difficult to incorporate into clinical practice. Relational coordination (RC) has been shown to improve performance and quality of care in health care settings. This study aims to demonstrate how applying RC theory to DESI implementation could elucidate underlying issues limiting widespread uptake.Five primary care clinics in Northern California participated in a DESI implementation project. We used a deductive thematic approach guided by behaviors outlined in RC theory to analyze qualitative data collected from ethnographic field notes documenting the implementation process and focus groups with health care professionals. We then systematically compared the qualitative findings with quantitative DESI distribution data.Based on DESI distribution rates, clinics were placed into 3 performance categories: high, middle, and low. Qualitative data illustrated how each clinic's performance related to RC behaviors. Consistent with RC theory, the high-performing clinic exhibited frequent, timely, and accurate communication and positive working relationships. The 3 middle-performing clinics exhibited high-quality communication within physician-staff teams but limited communication regarding DESI implementation across the clinic. The lowest-performing clinic was characterized by contentious relationships and inadequate communication.Limitations of the study include nonrandom selection of clinics and limited geographic diversity. In addition, ethnographic data collected documented only DESI implementation practices and not larger staff interactions contributing to RC.These findings suggest that a high level of RC within clinical settings may be a key component and facilitator of successful DESI implementation. Future attempts to integrate DESIs into clinical practice should consider incorporating interventions designed to increase positive RC behaviors as a potential means to improve uptake.

    View details for DOI 10.1177/0272989X15602886

    View details for PubMedID 26314727

  • Shared clinician- patient decision- making about treatment of pediatric asthma: what do we know and how can we use it? CURRENT OPINION IN ALLERGY AND CLINICAL IMMUNOLOGY Rivera-Spoljaric, K., Halley, M., Wilson, S. R. 2014; 14 (2): 161–67

    Abstract

    Shared decision-making (SDM) is an emerging field that promises to improve healthcare. We aim to explore the concept of SDM, how it has been studied or applied in the treatment of asthma, and how it might be implemented to improve adherence and outcomes in pediatric asthma.Healthcare providers often fail to involve their patients in clinical decision-making by not presenting all available options, associated risks and benefits, in light of the patient's values, preferences, concerns, lifestyle, and perceived barriers to following various treatment regimens. It has been argued that SDM is preferable to a clinician-controlled approach and may improve patient outcomes (increase satisfaction with care, reduce decisional conflict and decisional regret, improve health-related quality of life, and increase decision-specific knowledge). This may be especially important in managing chronic conditions in which adherence to treatment regimen may increase if the patient was actively involved in the decision-making. In pediatrics, the decision process is further complicated by the clinician-parent(s)-child interaction. We found no studies on how to effectively involve and communicate with children at different developmental levels, or how to coalesce the parent and child's perspective to work as a unit.SDM has the promise to improve satisfaction with disease management, treatment adherence and patient-centered outcomes in pediatric asthma, but further research is needed to determine its effectiveness and to establish guidelines on how to implement SDM in the clinical setting and incorporate the input and preferences of all stakeholders' perspectives.

    View details for DOI 10.1097/ACI.0000000000000046

    View details for Web of Science ID 000333256200014

    View details for PubMedID 24553296

  • Beyond barriers: fundamental 'disconnects' underlying the treatment of breast cancer patients' sexual health CULTURE HEALTH & SEXUALITY Halley, M. C., May, S. G., Rendle, K. A., Frosch, D. L., Kurian, A. W. 2014; 16 (9): 1169-1180

    Abstract

    Sexual health concerns represent one of the most frequently experienced and longest-lasting effects of breast cancer treatment, but research suggests that service providers rarely discuss sexual health with their patients. Existing research examining barriers to addressing patients' sexual health concerns has focused on discrete characteristics of the provider-patient interaction without considering the broader context in which these interactions occur. Drawing on the experiences of 21 breast cancer survivors, this paper explores three ways in which fundamental cultural and structural characteristics of the cancer care system in the USA may prevent breast cancer survivors from addressing their sexual health concerns, including: (1) when patients discussed sexual health with their providers, their providers approached sexuality as primarily physical, while participants experienced complex, multidimensional sexual health concerns; (2) specialisation within cancer care services made it difficult for patients to identify the appropriate provider to address their concerns; and (3) the structure of cancer care literally disconnects patients from the healthcare system at the time when sexual side effects commonly emerged. These data suggest that addressing breast cancer survivors' sexual health concerns requires a multifaceted approach to health systems change.

    View details for DOI 10.1080/13691058.2014.939227

    View details for Web of Science ID 000342208800012

  • Beyond barriers: fundamental 'disconnects' underlying the treatment of breast cancer patients' sexual health. Culture, health & sexuality Halley, M. C., May, S. G., Rendle, K. A., Frosch, D. L., Kurian, A. W. 2014; 16 (9): 1169-1180

    Abstract

    Sexual health concerns represent one of the most frequently experienced and longest-lasting effects of breast cancer treatment, but research suggests that service providers rarely discuss sexual health with their patients. Existing research examining barriers to addressing patients' sexual health concerns has focused on discrete characteristics of the provider-patient interaction without considering the broader context in which these interactions occur. Drawing on the experiences of 21 breast cancer survivors, this paper explores three ways in which fundamental cultural and structural characteristics of the cancer care system in the USA may prevent breast cancer survivors from addressing their sexual health concerns, including: (1) when patients discussed sexual health with their providers, their providers approached sexuality as primarily physical, while participants experienced complex, multidimensional sexual health concerns; (2) specialisation within cancer care services made it difficult for patients to identify the appropriate provider to address their concerns; and (3) the structure of cancer care literally disconnects patients from the healthcare system at the time when sexual side effects commonly emerged. These data suggest that addressing breast cancer survivors' sexual health concerns requires a multifaceted approach to health systems change.

    View details for DOI 10.1080/13691058.2014.939227

    View details for PubMedID 25138386

  • A conceptual model of the multiple stages of communication necessary to support patient-centered care. Journal of comparative effectiveness research Halley, M. C., Rendle, K. A., Frosch, D. L. 2013; 2 (4): 421–33

    Abstract

    Patient-centered care requires that both healthcare providers and patients have access to comparative effectiveness research (CER), which provides direct comparisons of the risks and benefits of available clinical options. However, insufficient attention has been paid to developing the comprehensive communication systems necessary to ensure that CER reaches patients and healthcare providers. In this review, we propose a model of the multiple stages of CER communication necessary for patient-centered care and review the existing research and gaps in knowledge relevant to each stage. These stages include: promotion of the underlying concepts and value of CER; translation of CER results; dissemination of CER results; and utilization of the results of CER in shared decision-making between patients and providers. A comprehensive approach to CER communication is necessary to ensure that the growing interest in and availability of CER is able to support a more patient-centered model of healthcare.

    View details for DOI 10.2217/cer.13.46

    View details for PubMedID 24236683

  • An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles. Health affairs (Project Hope) Lin, G. A., Halley, M., Rendle, K. A., Tietbohl, C., May, S. G., Trujillo, L., Frosch, D. L. 2013; 32 (2): 311–20

    Abstract

    Despite the proven efficacy of decision aids as interventions for increasing patient engagement and facilitating shared decision making, they are not used routinely in clinical care. Findings from a project designed to achieve such integration, conducted at five primary care practices in 2010-12, document low rates of distribution of decision aids to eligible patients due for colorectal cancer screening (9.3 percent) and experiencing back pain (10.7 percent). There were also no lasting increases in distribution rates in response to training sessions and other promotional activities for physicians and clinic staff. The results of focus groups, ethnographic field notes, and surveys suggest that major structural and cultural changes in health care practice and policy are necessary to achieve the levels of use of decision aids and shared decision making in routine practice envisioned in current policy. Among these changes are ongoing incentives for use, physician training, and a team-based practice model in which all care team members bear formal responsibility for the use of decision aids in routine primary care.

    View details for DOI 10.1377/hlthaff.2012.1070

    View details for PubMedID 23381524

  • The impact of "significant others" on breast cancer patients' treatment decision making. Journal of clinical oncology Rendle, K., Halley, M., Ventre, N., Kurian, A. W., Yu, P. P. 2012; 30 (34_): 20-?

    Abstract

    20 Background: Shared medical decision making (SDM) has been lauded by advocates for its potential to democratize the patient-physician relationship. However, the practice of SDM is still conceived of as largely a dyadic moment that exists between the patient and the physician. Few studies have looked at the role of significant others (spouses, partners, family members and friends) in decision making or considered how discussions and actions outside the consultation room affect a patient's medical decisions. This prospective study investigated the impact of significant others on the decision making deliberations of newly diagnosed breast cancer patients.Forty-one newly diagnosed breast cancer patients were interviewed at four critical time points throughout treatment to explore how they deliberated decisions with both care providers and significant others. Surveys assessing HRQOL, role preferences and treatment satisfaction along with EHR abstraction augmented interview data. Grounded theory analysis was used to identify recurrent themes in the qualitative data, and survey data were analyzed using IBM SPSS Statistics 20.Emergent themes from our analysis identified several factors that patients consider when faced with cancer treatment decisions, including 1) presentation of treatment options 2) patient or significant other conflict/concordance with care team recommendations 3) perceived risk of recurrence and 4) short and long term impact of treatment on daily life. Participants stressed the need for clinicians to view patients beyond diagnosis and recognize their larger care network as influential factors in their decision making.Our interviews highlight how the current healthcare delivery structure rarely acknowledges the circles of care that can exert influence on decision making. Lack of attention to non-clinical others can lead to sub-optimal medical decision making because these influences are not adequately understood by clinicians. Findings from this study suggest the need to enhance clinicians' and researchers' understanding of the influence of others in patients' treatment decision making, enabling them to intervene in these practices.

    View details for DOI 10.1200/jco.2012.30.34_suppl.20

    View details for PubMedID 28146982

  • A regional survey of dentists' preferences for hiring a dental associate. Journal of the American Dental Association (1939) Halley, M. C., Lalumandier, J. A., Walker, J. D., Houston, J. H. 2008; 139 (7): 973–79

    Abstract

    For many new dental school graduates, working as an associate may be an attractive option. To provide practical information for new job-seeking dentists, the authors conducted a survey to assess dentists' preferences with regard to hiring an associate.The authors mailed surveys to a random sample of 3,875 general dentists in four states that asked questions about the characteristics they preferred when hiring an associate. Five hundred seventy-four dentists (14.8 percent) responded to the survey.The results of this survey showed a wide variation in the characteristics dentists prefer when hiring an associate, but interpersonal skills appear to be at least as important as technical skills for new dentists' success.Opportunities for associate positions appear to be available to new dentists who have a range of skills, experience and training. Practical Implications. These results provide new dentists with information regarding the variety of career opportunities available for associates.

    View details for DOI 10.14219/jada.archive.2008.0285

    View details for PubMedID 18594084