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240 Shair collaborative: results from implementing SDM for breast cancer across North America
  1. Danielle Schubbe1,
  2. Renata W Yen1,2,
  3. Hannah Leavitt1,
  4. Rachel C Forcino3,
  5. Erica B Friedman4,
  6. Maureen Mcevoy5,
  7. Kari M Rosenkranz6,
  8. Kristin E Rojas7,
  9. Eloise Crayton8,
  10. Sherrill Jackson8,
  11. Myrtle Mitchell5,
  12. Ann Bradley1,
  13. A James O’malley1,
  14. Mary Politi9,
  15. Anna Na Tosteson1,
  16. Sandra L Wong6,
  17. Julie Margenthaler10,
  18. Marie-Anne Durand1,11,12,
  19. Glyn Elwyn1
  1. 1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
  2. 2Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
  3. 3Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
  4. 4Department of Surgery, New York University Langone Health, Bellevue Hospital, New York, NY, USA
  5. 5Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
  6. 6Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
  7. 7Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
  8. 8Breakfast Club, Florissant, MO, USA
  9. 9Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
  10. 10Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
  11. 11Centre Universitaire de Médecine Générale Et Santé Publique, Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
  12. 12UMR 1295, CERPOP, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France


Introduction Shared decision-making (SDM) in breast cancer care lacks routine implementation. We initiated the SHared decision-making Adoption and Implementation Resource (SHAIR) online coproduction learning collaborative to promote early-stage breast cancer surgery SDM by implementing effective text and picture-enhanced conversation aids in preoperative care after brief training.1 2

Methods We are conducting a phased implementation: phase 1 pilot at five sites and phase 2 scale-up across additional North American sites. We are using RE-AIM for evaluation3 and a feedback dashboard for displaying primary and some secondary outcomes to SHAIR sites. Our primary outcome is patient reach. Secondary outcomes include patient-reported SDM (collaboRATE), decisional conflict (SURE), healthcare delivery integration (integRATE), treatment choice, intervention normalization (Normalization MeAsure Development questionnaire4), intervention adaptation (Framework for Reporting Adaptations and Modifications-Extended/-Implementation Strategies5), implementation strategies, and sustainability (working with the American Society of Breast Surgeons).

Results Across 15 sites, SHAIR has reached 1,553 patients, reaching 85% of all eligible patients. Patient surveys (n=279) report: (1) CollaboRATE with 72.5% top score (n=169/233); (2) integRATE with 10.46/12 (n=230/279); (3) SURE (decisional conflict) with 87.45% top score (n=202/231); and (4) treatment choice preferences, with over half reporting choosing lumpectomy with radiation. The American Society of Breast Surgeons will offer access to the conversion aids and SHAIR-developed brief SDM training on its forum and website. Final SHAIR results, including NoMAD and FRAME results, in June 2024.

Discussion SHAIR has reached a significant proportion of the eligible patient population at participating sites and patients are reporting high SDM.

Conclusion(s) Providing access to CAs, brief training, and feedback dashboard within a learning collaborative has led to significant patient reach. We will report final results in June 2024.

This research was funded through a Patient-Centered Outcomes Research Institute Award (SDM-2020C2–20307). This work is solely the responsibility of the authors and does not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

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