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012 Implementation and effectiveness of shared decision- making supported by outcome information regarding surveillance after breast cancer – results of the shout-BC study
  1. Jet W Ankersmid1,2,
  2. Cornelia F van Uden1,
  3. Constance HC Drossaert3,
  4. Luc JA Strobbe1,4,
  5. Yvonne EA Van Riet1,5,
  6. Ellen G Engelhardt1,
  7. Anne MH Vogelaar1,
  8. Sabine Siesling2,6
  1. 1Santeon, Utrecht, The Netherlands
  2. 2Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
  3. 3Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
  4. 4Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
  5. 5Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
  6. 6Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

Abstract

Introduction Integrating outcome information in shared decision-making (SDM) can enhance its effectiveness. The Breast Cancer Surveillance Decision Aid (BCS-PtDA) supports SDM about (personalized) surveillance and integrates personal risk estimations of the risk for recurrences and outcome information on fear of recurrences. The SHOUT-BC study aimed to evaluate the effectiveness and implementation of SDM – supported by the BCS-PtDA – about (personalized) surveillance after breast cancer.

Methods The study employed a prospective multiple interrupted time series (ITS) design across eight Dutch teaching hospitals and consisted of three phases: pre-implementation, implementation, and post- implementation. Data were collected using hospital registry data, log data, audio-recordings and questionnaires completed by breast cancer survivors (around one year after surgery) and health care professionals (HCPs).

Results Patients’ perceived involvement in decision-making post-implementation (primary outcome, SDM-Q-9) increased significantly. Patients evaluated the BCS-PtDA positively and reported a more active role in decision-making, decreased decisional conflict, and increased knowledge. The average implementation and participation rates of the PtDA were 26% and 61%, respectively. HCPs found that the BCS-PtDA supported creation of choice awareness. Reported barriers for implementation included increased workload and perceived lack of benefits. Consultation analysis showed that while patients were offered choices, deliberation was limited.

Discussion Despite increased perceived patient involvement in SDM and positive evaluations of the BCS-PtDA, implementation rates remained relatively low.

Conclusions The BCS-PtDA leads to enhanced patient involvement in SDM and improved quality of decision-making about surveillance after breast cancer. When the BCS-PtDA was used, patients were clearly given a choice, but information provision and SDM application can be improved. Improvements regarding implementation are necessary to optimize the SDM process.

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