Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 23;23(1):164.
doi: 10.1186/s12911-023-02263-8.

Implementing shared decision-making interventions in breast cancer clinical practice: a scoping review

Natalia Oprea  1 , Vittoria Ardito  2 , Oriana Ciani  2
Affiliations

Implementing shared decision-making interventions in breast cancer clinical practice: a scoping review

Natalia Oprea et al. BMC Med Inform Decis Mak. .

Abstract

Background: Shared decision-making (SDM) is a collaborative process whereby patients and clinicians jointly deliberate on the best treatment option that takes into account patients' preferences and values. In breast cancer care, different treatment options have become available to patients in the last decade. Various interventions, including patient decision aids (PtDAs), have been designed to promote SDM in this disease area. This study aimed at investigating the factors that influence the successful adoption and implementation of SDM interventions in real-world healthcare delivery settings.

Methods: A scoping review of scientific and grey literature was conducted for the period 2006-2021 to analyse the support for SDM interventions and their adoption in breast cancer clinical practice. The interpretation of findings was based on the Practical, Robust Implementation and Sustainability Model (PRISM) for integrating research findings into practice.

Results: Overall, 19 studies were included for data synthesis, with more than 70% published since 2017. The availability of SDM tools does not automatically translate into their actual use in clinical settings. Factors related to users' co-creation, the clinical team's attitude and knowledge, organisational support and regulatory provisions facilitate the adoption of SDM interventions. However, overlooking aspects such as the re-organisation of care pathways, patient characteristics, and assigning of resources (human, financial, and facilities) can hinder implementation efforts.

Conclusions: Compared to the mounting evidence on the efficacy of SDM interventions, knowledge to support their sustained implementation in daily care is still limited, albeit results show an increasing interest in strategies that facilitate their uptake in breast cancer care over time. These findings highlight different strategies that can be used to embed SDM interventions in clinical practice. Future work should investigate which approaches are more effective in light of organisational conditions and external factors, including an evaluation of costs and healthcare system settings.

Keywords: Breast cancer; Implementation; PRISM framework; Patient decision aids; Shared decision-making.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of data searches and source selection
Fig. 2
Fig. 2
The PRISM Framework categories anticipating implementation factors of SDM  interventions in BC care
See this image and copyright information in PMC

References

    1. Pizzoli SFM, Renzi C, Arnaboldi P, Russell-Edu W, Pravettoni G. From life-threatening to chronic disease: Is this the case of cancers? A systematic review. Monacis L, editor. Cogent Psychol. 2019;6(1):1577593. doi: 10.1080/23311908.2019.1577593. - DOI
    1. Society AC . Managing cancer as a chronic illness. 2019.
    1. O’Connor A, Llewellyn-Thomas H, Stacey D. IPDAS collaboration background document. 2005.
    1. Elwyn G, O’Connor A, Stacey D, Volk R, Coulter A, Thomson R, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333(7565):417. doi: 10.1136/bmj.38926.629329.AE. - DOI - PMC - PubMed
    1. Barry MJ, Edgman-Levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–781. doi: 10.1056/NEJMp1109283. - DOI - PubMed

Publication types