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

2020 ◽  
Author(s):  
Danielle Schubbe ◽  
Renata W. Yen ◽  
Catherine H. Saunders ◽  
Glyn Elwyn ◽  
Rachel C. Forcino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Patient Portal ◽  
Shared Decision ◽  
Structured Interviews ◽  
Sustained Use ◽  
The Future

Abstract 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 improved shared decision making and 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 and 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 was similar to 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, https://clinicaltrials.gov/ct2/show/NCT03136367

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Danielle Schubbe ◽  
Renata W. Yen ◽  
Catherine H. Saunders ◽  
Glyn Elwyn ◽  
Rachel C. Forcino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Patient Portal ◽  
Shared Decision ◽  
Structured Interviews ◽  
Sustained Use ◽  
The Future

Abstract 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

scholarly journals Implementation and Sustainability Factors of Two Early-Stage Breast Cancer Conversation Aids in Diverse Practices

2020 ◽  
Author(s):  
Danielle Schubbe ◽  
Renata W. Yen ◽  
Catherine H. Saunders ◽  
Glyn Elwyn ◽  
Rachel Forcino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Surgery ◽  
Cancer Center ◽  
Patient Portal ◽  
Structured Interviews ◽  
Sustained Use ◽  
The Future

Abstract BackgroundConversation aids can facilitate shared decision making and improve patient-centered outcomes. However, there are few examples of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored strategies that will promote the sustained use of two early-stage breast cancer conversation aids. We examined any differences in experiences and opinions between the two conversation aids and across socioeconomic strata. MethodsWe nested this study within a randomized controlled trial evaluating two early-stage breast cancer surgery treatment conversation aids, one text-based and one picture-based, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a sample of patient participants, purposively sampled across conversation aid assignment and socioeconomic status (SES), and collected observations and field-notes. We also interviewed trial surgeons and other stakeholders. We conducted a framework analysis of all interviews, notes, and observations with two independent coders using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on which conversation aid was used/received and patient SES. ResultsWe 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 was similar to their usual care after using it a few times, and most patients felt it appeared part of their normal routine. ConclusionsKey factors that will help guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics and communication preferences.Trial registrationNCT03136367 at ClinicalTrials.gov

“It’s important to me”: A qualitative analysis of shared decision-making and patient preferences in early-stage breast cancer patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 227-227
Author(s):  
Valerie Lawhon ◽  
Rebecca England ◽  
Audrey S. Wallace ◽  
Courtney Williams ◽  
Stacey A. Ingram ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Early Stage ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Early Stage Breast Cancer ◽  
Shared Decision ◽  
Treatment Decision Making

227 Background: Shared decision-making (SDM) occurs when both patient and provider are involved in the treatment decision-making process. SDM allows patients to understand the pros and cons of different treatments while also helping them select the one that aligns with their care goals when multiple options are available. This qualitative study sought to understand different factors that influence early-stage breast cancer (EBC) patients’ approach in selecting treatment. Methods: This cross-sectional study included women with stage I-III EBC receiving treatment at the University of Alabama at Birmingham from 2017-2018. To understand SDM preferences, patients completed the Control Preferences Scale and a short demographic questionnaire. To understand patient’s values when choosing treatment, semi-structured interviews were conducted to capture patient preferences for making treatment decisions, including surgery, radiation, or systemic treatments. Interviews were audio-recorded, transcribed, and analyzed using NVivo. Two coders analyzed transcripts using a constant comparative method to identify major themes related to decision-making preferences. Results: Amongst the 33 women, the majority of patients (52%) desired shared responsibility in treatment decisions. 52% of patients were age 75+ and 48% of patients were age 65-74, with an average age of 74 (4.2 SD). 21% of patients were African American and 79% were Caucasian. Interviews revealed 19 recurrent treatment decision-making themes, including effectiveness, disease prognosis, physician and others’ opinions, side effects, logistics, personal responsibilites, ability to accomplish daily activities or larger goals, and spirituality. EBC patient preferences varied widely in regards to treatment decision-making. Conclusions: The variety of themes identified in the analysis indicate that there is a large amount of variability to what preferences are most crucial to patients. Providers should consider individual patient needs and desires rather than using a “one size fits all” approach when making treatment decisions. Findings from this study could aid in future SDM implementations.

Taking control of cancer: Why women are choosing mastectomy.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 108-108
Author(s):  
Andrea Marie Covelli ◽  
Nancy N. Baxter ◽  
Margaret Fitch ◽  
Frances Catriona Wright
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Survival Advantage ◽  
Early Stage Breast Cancer ◽  
Fear Of Recurrence ◽  
Cancer Center ◽  
Structured Interviews ◽  
Extensive Surgery

108 Background: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing since 2003. More extensive surgery is not a benign procedure without the risk of complications. Studies suggest that the increase is due to women choosing UM and CPM; we do not know what factors are influencing the choice for more extensive surgery. Methods: We conducted a qualitative study using grounded theory to identify factors for the choice of mastectomy. Purposive sampling was used to identify women across the Toronto Area (Ontario, Canada), who were suitable candidates for breast conserving surgery (BCS) but underwent UM or CPM. Data were collected through semi-structured interviews. Constant comparative analysis identified key concepts and themes. Results: Data saturation was achieved after 29 in-person interviews. 12 interviewees were treated at academic cancer centers, 6 at an academic non-cancer center and 11 at community centers. 15 women underwent UM; 14 underwent UM+CPM. Median age was 55. ‘Taking control of cancer’ was the dominant theme. Fear of breast cancerwas expressed at diagnosisand remains throughout decision making. Fear translates into the overestimated risk of local recurrenceand contralateral cancer. Despite discussion of the equivalence of BCS and UM, patients chose UM due to fear of recurrence and misperceived survival advantage. Similarly, patients chose CPM to eliminate the risk of contralateral cancer and misperceived survival advantage. Women were actively trying to Control Outcomes, as more surgery was seen as greater control. Conclusions: Women seeking UM and CPM for treatment of their early stage breast cancer manage their fear of cancer by undergoing more extensive surgery which in turn drives mastectomy rates. It is important to understand this process so that we may improve our ability to discuss issues of importance to women and facilitate informed decision-making.

Exploring and supporting older women’s chemotherapy decision-making in early-stage breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 181-181
Author(s):  
Meghan Sri Karuturi ◽  
Ashley Housten ◽  
Sharon H. Giordano ◽  
Diana Hoover ◽  
Robert Joseph Volk
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Adjuvant Chemotherapy ◽  
Shared Decision Making ◽  
Early Stage ◽  
Decision Making Process ◽  
Shared Decision ◽  
Single Item ◽  
Neo Adjuvant Chemotherapy

181 Background: Few studies have focused on the therapeutic decision-making process in older adults with cancer. This study sought to address this gap by exploring older adult breast cancer patients’ (pts) perspectives on neo/adjuvant chemotherapy, thereby identifying informational needs as they navigate the decision-making process. Methods: Women ≥65 years diagnosed with early stage (I-III) breast cancer were recruited from an academic center following their decision on whether to receive neo/adjuvant chemotherapy. Pts took part in individual semi-structured interviews to explore their perspectives, knowledge, and values. They also completed surveys assessing sociodemographics, health literacy/numeracy, and shared decision-making (SDM-Q-9). Interviews were audio-recorded and transcribed, and analyzed using the Sort and Sift, Think and Shift qualitative approach. Quantitative data was summarized using descriptive statistics. Results: 26 pts completed interviews (age range 65-92; 81% non-Hispanic White; 81% ≥ college degree; 70% single). 14 pts elected to undergo chemotherapy and 11 declined. Most pts had adequate health literacy (mean = 4.31; SD = 1.1 on Single Item Literacy Scale) and numeracy (mean = 4.4; SD = 1.0 on Single Item Numeracy Scale). Pts scored high on the shared decision-making questionnaires (SDM-Q-9, mean = 5.3, SD = 0.7). Thematic analysis uncovered several commonalities regardless of the decision. Pts sought information regarding their disease/treatment, but in some instances were confused regarding the objective of chemotherapy. They often chose treatment outside of the physician’s recommendation, and referenced the subjective experience of friends/family members with cancer. Self-perception of health and the side-effects of chemotherapy were also key factors. Pts also placed importance on the maintenance of quality of life throughout the treatment trajectory. Conclusions: Decision-making strategies in older patients were shaped by knowledge, values and the anectodal experience of others. These discussions will subsequently shape the creation of a decision support tool for older pts and physicians to better facilitate the shared-decision making process.

What Is the Impact of Shared Decision Making on Treatment and Outcomes for Older Women With Breast Cancer?

2006 ◽  
Vol 24 (30) ◽  
pp. 4908-4913 ◽  
Author(s):  
Jeanne Mandelblatt ◽  
Barbara Kreling ◽  
Melissa Figeuriedo ◽  
Shibao Feng
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Older Women ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Early Stage ◽  
Shared Decision ◽  
Process Of Care ◽  
Short Term ◽  
The Impact

Purpose Shared decision making (SDM) has been recommended as a standard of care, especially when there are treatment alternatives or uncertainty in outcomes. However, we know little about use of SDM in cancer care, and even less is known about SDM in older patients. We describe patient and physician determinants of SDM in older women with breast cancer and evaluate whether SDM is associated with treatment patterns or short-term outcomes of care. Patients and Methods Women age 67 or older treated for early stage breast cancer in 29 sites from five geographic regions comprise the study sample (N = 718). Data were obtained from patients by in-person and telephone interviews. Physician data were collected via survey, and medical records were reviewed to ascertain comorbidity and tumor characteristics. Random effects and logistic regression models were used to assess associations between SDM and other factors. Results Women who were age 67 to 74 years (v 75 or older) were accompanied to consultation and who sought information reported the highest SDM, after considering covariates. While SDM was not associated with surgical treatment, greater SDM was associated with higher odds of having adjuvant treatment, controlling for clinical factors. Greater SDM was also associated with improved short-term satisfaction. Conclusion SDM plays an important role in the process of care for older women with breast cancer. Physicians treating this growing population have a simple, but powerful tool for improving outcomes within their grasp—spending time to engage and involve older women in their breast cancer care.

scholarly journals Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

2021 ◽  
Vol 18 (4) ◽  
pp. 2128
Author(s):  
Marta Maes-Carballo ◽  
Manuel Martín-Díaz ◽  
Luciano Mignini ◽  
Khalid Saeed Khan ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Societies ◽  
New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

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