TY - JOUR
T1 - Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices
AU - Schubbe, Danielle
AU - Yen, Renata W.
AU - Saunders, Catherine H.
AU - Elwyn, Glyn
AU - Forcino, Rachel C.
AU - O’Malley, A. James
AU - Politi, Mary C.
AU - Margenthaler, Julie
AU - Volk, Robert J.
AU - Sepucha, Karen
AU - Ozanne, Elissa
AU - Percac-Lima, Sanja
AU - Bradley, Ann
AU - Goodwin, Courtney
AU - van den Muijsenbergh, Maria
AU - Aarts, Johanna W. M.
AU - Scalia, Peter
AU - Durand, Marie-Anne
N1 - Funding Information: The research reported in this manuscript is funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (1511-32875). The statements presented in this manuscript are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. Funding Information: We want to thank all the patients who took part in this study. We also want to thank their families, the participating trial clinicians and all clinic staff, and prior students and research assistants who contributed to this work (Julia Song, Thomas del Guercio, Nageen Mir, Sophie Czerwinski, Abigail Ward, Sarah Cohen, and Natasha Kurien). Additionally, we also want to acknowledge our trial?s Community Advisory Board members, Data Safety and Monitoring Board, and Trial Steering Group for their invaluable input and guidance. Trustees of Dartmouth College Office of Sponsored Projects, 11 Rope Ferry Road #6210, Hanover, NH, 03755, sponsored.projects@dartmouth.edu The study sponsor has no role in any aspects of the setup or execution of the study or manuscript. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods: We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. Results: We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions: Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. Trial registration: ClinicalTrials.gov Identifier: NCT03136367, registered on May 2, 2017
AB - Background: Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods: We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. Results: We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions: Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. Trial registration: ClinicalTrials.gov Identifier: NCT03136367, registered on May 2, 2017
KW - Breast cancer
KW - Conversation aid
KW - Decision aid
KW - Encounter decision aid
KW - Encounter patient decision aid
KW - Health communication
KW - Implementation
KW - Normalization Process Theory
KW - Qualitative research
KW - Shared decision-making
UR - http://www.scopus.com/inward/record.url?scp=85105548623&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13012-021-01115-1
DO - https://doi.org/10.1186/s13012-021-01115-1
M3 - Article
C2 - 33971913
SN - 1748-5908
VL - 16
JO - IMPLEMENTATION SCIENCE
JF - IMPLEMENTATION SCIENCE
IS - 1
M1 - 51
ER -