A conversation with medical decision-making expert Mary Politi 

As a doctoral student in clinical health psychology, Mary Politi worked in hospitals counseling patients with chronic health conditions including cancer. Her training had prepared her to help people understand their diagnoses, adopt healthy behaviors and cope with the psychological effects of having a chronic illness. But it left her unprepared to help newly diagnosed people choose among their treatment options — and that was the help they needed most acutely.

“Most of the struggles people had at the time were about what to do with all of this information they were being given by their care teams,” said Politi, PhD, now a professor at Washington University in St. Louis School of Public Health. “They had no idea how to make sense of it, and it was overwhelming. So I started looking into it, and I found there was a whole field on shared decision-making. There’s a science behind how we help people make better choices when they’re in that peak experience of care.”

Politi has since built a career around this science, focusing on how health-care teams and patients can make medical decisions together. 

Before coming to the School of Public Health, she was a professor at WashU Medicine. There, her team developed several tools to support people’s health decisions — decisions involving dermatology, surgery, health insurance, and cancer screening and treatment. For example, they worked on a tool to help patients make decisions regarding breast reconstruction after mastectomy. She and colleagues in infectious diseases and plastic surgery created personalized risk models to show individual patients the likelihood of complications — aiding clinicians in counseling them on the best options.

At the School of Public Health, Politi is advancing her research and, this semester, teaching a class, “Public Health and Medicine: Health Decision-Making,” to undergraduates in the university’s Public Health & Society Program. The course attracts a diverse group of students — psychology and business majors, students interested in sustainable design — reflecting the field’s interdisciplinary nature.

“I really enjoy teaching,” she said. “I’m learning from the students in addition to teaching about decision-making. I get some of the best ideas from people who bring new perspectives to my work.”  

Here, Politi discusses her work and her move to the school. 

Q: Can you tell us more about your shared decision-making project involving breast reconstruction?

“We built a decision tool that personalized patients’ risk of complication from reconstruction after a mastectomy. Colleagues in infectious diseases helped us develop a personalized risk-prediction model so that individual patients could know their likelihood of a complication after surgery. Their clinicians also would know about the risks, so they could better counsel patients about what might work for them. 

“We built this tool outside of the electronic health record system at first, and then clinicians asked us to put it in the electronic health record system because they felt they would use it more there. One of the downsides of that model was that people weren’t always getting the risk information if they weren’t connected to the electronic system yet. … Since then, we have received requests from patients and community partners to make it more easily shared outside of the hospital’s electronic health system. 

“We have just written an adaptation process with colleagues in implementation science regarding how you adapt a tool originally developed for the clinic so that it can be used more broadly by the public.” 

Q: Why did you move to the School of Public Health? 

“The School of Public Health supports  the research, teaching, and collaboration I have engaged in during my whole career. It’s very interdisciplinary. Finding people where they are accessing health information, where they are receiving care, getting them the best information we have, and following them across the whole continuum of the care experience, from community to clinic to follow-up needs. 

“There are experts here in implementation science and dissemination science. There are experts in health services research, in health policy, and all of those aspects relate to what I’m doing. Our leadership model values all of the pieces of our jobs, which I think is another strength of the school.” 

Q:  How do you feel your work will progress or change at the school? 

“What I am most excited about within the school are the research networks. My work has always been interdisciplinary. I have used implementation science research methods within the shared decision-making field, so the Dissemination & Implementation Science Innovation Research Network (DISIRN) is highly relevant. The Policy and Structural Solutions (PS2) network — I could learn a lot from many of the methods they use. For example, epidemiology models to help predict risks for individuals, which is relevant to their decisions. The Health Communication Collaborative can support translating information in ways that resonate with people’s needs. All of the networks have methods or approaches that could enhance some of the work I’m doing.

“I love the interdisciplinary aspect of the school and the tangible ways people are working together to solve complex problems. I have great colleagues here. I find something to talk about with everybody, whether it’s our primary research goal or just something that we’re interested in.” 

Q: Tell us about your other role at the school.

“My administrative role is director of faculty development within the Office of Faculty Affairs. I support fellow faculty members’ career development and their trajectory from early career, or pre-tenure, all the way through leadership development.” 

Q: What gets you up in the morning to come do what you do here? 

“Whenever we have something that benefits people, whether it’s students, patients, or the public, that’s really motivating. When I hear from someone that this tool has changed the way someone has delivered care as a clinician, or if we get data that something we’ve built is really facilitating personalized care and shared decision-making, I get excited by that. 

“The idea of building something new is exciting, watching it evolve. The School of Public Health is going in a great direction and already had a strong foundation. And everyone’s voices here are heard. Whether it’s a staff member or a senior leader, they’re all valued, they’re all important. And that’s the way my lab and research team has always operated. I love seeing that that can be done even on such a large scale, the whole school.”