TY - JOUR
T1 - Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams
AU - van Veenendaal, Haske
AU - Voogdt-Pruis, Helene R.
AU - Ubbink, Dirk T.
AU - van Weele, Esther
AU - Koco, Lejla
AU - Schuurman, Maaike
AU - Oskam, Jannie
AU - Visserman, Ella
AU - Hilders, Carina G. J. M.
N1 - Funding Information: An unrestricted educational grant was provided by Zilveren Kruis Healthcare Insurance Company and the Dutch Ministry of Health , Grant Number is Z670 . Welfare and Sport. In-kind support was provided by the participating hospitals. Publisher Copyright: © 2021 The Authors
PY - 2022/1
Y1 - 2022/1
N2 - Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the ‘Measurement Instrument for Determinants of Innovations-model’ (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
AB - Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the ‘Measurement Instrument for Determinants of Innovations-model’ (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
KW - Implementation
KW - Implementation science, barriers and facilitators
KW - Shared decision making
KW - Timeout, breast cancer care
UR - http://www.scopus.com/inward/record.url?scp=85106328091&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.pec.2021.05.005
DO - https://doi.org/10.1016/j.pec.2021.05.005
M3 - Article
C2 - 34016497
SN - 0738-3991
VL - 105
SP - 114
EP - 127
JO - Patient Education and Counseling
JF - Patient Education and Counseling
IS - 1
ER -