My research and clinical interests involve developing, evaluating and implementing tools to improve the quality of significant medical decisions. The goal of my work is to ensure that all patients who face significant medical decisions, are meaningfully engaged, well-informed, and received treatments that match their goals. I was the medical editor for a series of five decision aids for breast cancer produced by the Informed Medical Decision Making Foundation. The decision aids have won several awards and I have led efforts to disseminate these widely. One of the barriers that we have found to using decision aids is a lack of awareness on the part of patients and providers of the large gaps in decision qualityâ€”such as how little many patients understand about the choices they face and how often the treatments patients receive do not meet their goals and preferences. To address this, I have been leading a large multi-institution research project to develop decision quality instruments across a range of decisions such as breast cancer surgery, breast reconstruction and systemic therapy. The survey instruments measure patientsâ€™ knowledge, their involvement in decisions and the extent to which treatments reflect their goals. I have also been working on studies to examine decision making for prophylactic mastectomy, and impact of biomarker information on patients and providers decisions.