Grant Application

Carl Snyderman, MD, MBA, Benita Valappil, MPH, Igor Linkov, PhD, Faina Linkov, PhD, MPH, UPMC Presbyterian

Proposed Innovation

Patients with complex medical problems are burdened with tough choices regarding best treatment options. Treatment choices are adversely affected by a number of factors: lack of evidence-based information; clinical bias of healthcare providers; uncertainty of outcomes; influence of others; and emotional bias and stress.

This project was designed to improve the decision making process through the development of a tool involving collaborative consideration of the patient’s values and select treatment options.


During the initial phase of the project, a paper-based decision tool was developed to improve the decision making process for patients with complex medical problems such as acoustic neuromas (also known as a vestibular schwannoma.)

Benchmarks were established based on focus group results, background research, and data collection. In addition, decision criteria were established through patient focus groups and discussions with clinicians. An exhaustive review of the medical literature helped to define outcomes for key decision factors while a consensus panel of surgeons and radiation therapists provided missing data.


During the trial phase, the decision-making tool was used in the otolaryngology clinic to help patients choose the best line of therapy when diagnosed with an acoustic neuroma. Results from both project phases are now being used to develop an online decision support tool that can be shared with other sites.

An article written about the project  —“Development of an evidence-based decision pathway for vestibular schwannoma treatment options” — was published in the American Journal of Otolaryngology.  Editors and reviewers described it as “helpful for patients and practitioners” and “a useful tool for patients, particularly when they are faced with multiple options” for managing their illness.