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Randomized Controlled Trial
. 2021 May 10;16(1):51.
doi: 10.1186/s13012-021-01115-1.

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

Danielle Schubbe  1 , Renata W Yen  1 , Catherine H Saunders  1   2 , Glyn Elwyn  1 , Rachel C Forcino  1 , A James O'Malley  1 , Mary C Politi  3 , Julie Margenthaler  3 , Robert J Volk  4 , Karen Sepucha  5 , Elissa Ozanne  6 , Sanja Percac-Lima  7 , Ann Bradley  1 , Courtney Goodwin  3 , Maria van den Muijsenbergh  8 , Johanna W M Aarts  9 , Peter Scalia  1 , Marie-Anne Durand  10   11   12
Affiliations
Randomized Controlled Trial

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

Danielle Schubbe et al. Implement Sci. .

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.

Keywords: Breast cancer; Conversation aid; Decision aid; Encounter decision aid; Encounter patient decision aid; Health communication; Implementation; Normalization Process Theory; Qualitative research; Shared decision-making.

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Conflict of interest statement

● Glyn Elwyn has edited and published books that provide royalties on sales by the publishers: the books include Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). Glyn Elwyn’s academic interests are focused on shared decision-making and coproduction. He owns copyright in measures of shared decision-making and care integration, namely collaboRATE, integRATE (measure of care integration), consideRATE (patient experience of care in serious illness), coopeRATE (measure of goal setting), toleRATE (clinician attitude to shared decision-making), Observer OPTION-5, and Observer OPTION-12 (observer measures of shared decision-making). He has in the past provided consultancy for organizations, including (1) Emmi Solutions, LLC who developed patient decision support tools; (2) National Quality Forum on the certification of decision support tools; (3) Washington State Health Department on the certification of decision support tools; (4) SciMentum LLC, Amsterdam (workshops for shared decision-making). He is the Founder and Director of &think LLC, which owns the registered trademark for Option GridsTM patient decision aids; Founder and Director of SHARPNETWORK LLC, a provider of training for shared decision-making. He provides advice in the domain of shared decision-making and patient decision aids to (1) Access Community Health Network, Chicago (Adviser to Federally Qualified Medical Centers); (2) EBSCO Health for Option GridsTM patient decision aids (consultant); (3) Bind on Demand Health Insurance (consultant); (4) PatientWisdom Inc (adviser); (5) abridge AI Inc (Chief Clinical Research Scientist).

● Glyn Elwyn and Marie-Anne Durand have developed the Option Grid conversation aids, which are licensed to EBSCO Health. They receive consulting income from EBSCO Health and may receive royalties in the future. Marie-Anne Durand was a consultant for ACCESS Community Health Network until 2019.

● From 2014-2018, Dr. Karen Sepucha received salary support as a member of the scientific advisory board for Healthwise, a not-for-profit foundation that develops and distributes patient education and decision support materials.

● Catherine Hylas Saunders holds copyright in the consideRATE suite of tools.

No other competing interests declared.

References

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