Quality healthcare must make use of the best available evidence while also attempting to accommodate patients' worldviews whenever possible. Worldviews are beliefs, values and assumptions about the world that are part of the psychosocial lens through which people interpret new experiences. In order to take patients' worldviews seriously clinicians must first recognize that they have their own worldview (as manifest by their own beliefs, values and assumptions) and appreciate that their own worldview may shape their clinical decisions. Furthermore, inevitably patients bring their worldviews to their healthcare experience, and patient worldviews may differ from those of their physicians. By calling attention to patient and clinicians beliefs, values and assumptions and by promoting the candid articulation of those beliefs and valudes in the clinical interaction, Dr. Tilburt's research projects each identify barriers and promoters shared-decision making, especially in cross-cultural settings. Much of his work focuses on various aspects of beliefs and values that influence decision making and care processes in cancer control.

Most recently, in a close collaboration between Bioethics Research, the Knowledge and Encounter Research (KER) Unit and the Survey Research Center at Mayo, we are beginning to describe the beliefs, values and assumptions that can influence the eventual clinical translation of new cancer biomarkers of prostate cancer. In the coming decades, prostate specific antigen (PSA) will likely to be eclipsed by more powerful, but more complicated biomarker panels that will require the best possible conversations about screening and recurrence monitoring between patients and doctors. This involves a three-pronged strategy:

With these studies we will be prepared to improve the process of shared decision-making in prostate cancer survivorship in a manner that is robustly patient-centered (i.e., responsive to the deepest hopes, fears, beliefs, and values of patients) and evidence-based.

In close collaboration with tribes in Minnesota and Alaska and under a Memorandum of Understanding with the US Indian Health Service, we are also studying quality of care among American Indian and Alaska Native men with elevated PSA. The goal of this community-based participatory research project is to assess the patterns of care for American Indian and Alaska Native men from Minnesota and Alaska who have had an incident elevation in their PSA test. These methods could then be used to ascertain individual and health system factors that may affect disparities in care for AI/AN men and may lay the groundwork for prostate cancer control strategies that are culturally sensitive and evidence-based.

Because of his strong interest in cancer care, in addition to his primary appointment in General Internal Medicine and the Bioethics Research Program, Dr. Tilburt holds an appointment in the Mayo Clinic Cancer Center.