Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices.

Détails

ID Serval
serval:BIB_6ED961918EA9
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices.
Périodique
Implementation science
Auteur⸱e⸱s
Schubbe D., Yen R.W., Saunders C.H., Elwyn G., Forcino R.C., O'Malley A.J., Politi M.C., Margenthaler J., Volk R.J., Sepucha K., Ozanne E., Percac-Lima S., Bradley A., Goodwin C., van den Muijsenbergh M., Aarts JWM, Scalia P., Durand M.A.
ISSN
1748-5908 (Electronic)
ISSN-L
1748-5908
Statut éditorial
Publié
Date de publication
10/05/2021
Peer-reviewed
Oui
Volume
16
Numéro
1
Pages
51
Langue
anglais
Notes
Publication types: Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Résumé
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.
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.
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.
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.
ClinicalTrials.gov Identifier: NCT03136367 , registered on May 2, 2017.
Mots-clé
Breast Neoplasms/therapy, Communication, Decision Making, Decision Making, Shared, Decision Support Techniques, Female, Humans, Patient Participation, Breast cancer, Conversation aid, Decision aid, Encounter decision aid, Encounter patient decision aid, Health communication, Implementation, Normalization Process Theory, Qualitative research, Shared decision-making
Pubmed
Web of science
Open Access
Oui
Création de la notice
19/05/2021 15:36
Dernière modification de la notice
09/01/2024 8:15
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