Journal Article

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

Ozanne, Elissa, Durand, Marie-Anne, Saunders, Catherine H., Aarts, Johanna W. M., Politi, Mary C., Margenthaler, Julie, Yen, Renata W., Forcino, Rachel C., O’Malley, A. James, Schubbe, Danielle, Percac-Lima, Sanja, van den Muijsenbergh, Maria, Goodwin, Courtney, Sepucha, Karen, Elwyn, Glyn, Scalia, Peter, Bradley, Ann, Volk, Robert J.

2021

Overview

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

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Breast cancer / Breast Neoplasms - therapy / Care and treatment / Clinics / Communication / Conversation aid / Decision aid / Decision Making / Decision Making, Shared / Decision Support Techniques / Electronic health records / Encounter decision aid / Encounter patient decision aid / Evaluation / Female / Health Administration / Health communication / Health education / Health Informatics / Health literacy / Health Policy / Health Promotion and Disease Prevention / Health Services Research / Humans / Intervention / Interviews / Life Sciences / Mastectomy / Medical personnel / Medicine / Medicine & Public Health / Patient education / Patient Participation / Patients / Physician and patient / Preferences / Public Health / Radiation / Shared decision making / Social aspects / Socioeconomic factors / Socioeconomics / Stakeholders / Surgeons / Sustainability / Verbal communication