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140 Exploring participation in an online breast cancer coproduction learning collaborative
  1. Hannah Leavitt1,
  2. Jaclyn Engel2,
  3. Danielle Schubbe1,
  4. Renata W Yen1,
  5. Rachel C Forcino3,
  6. Erica B Friedman4,
  7. Maureen Mcevoy5,
  8. Kari M Rosenkranz6,
  9. Kristin E Rojas7,
  10. Eloise Crayton8,
  11. Sherrill Jackson8,
  12. Myrtle Mitchell9,
  13. Ann Bradley1,
  14. A James O’malley1,
  15. Mary Politi9,
  16. Anna Na Tosteson1,
  17. Sandra L Wong6,
  18. Julie Margenthaler10,
  19. Marie-Anne Durand1,11,12,
  20. Glyn Elwyn1
  1. 1Coproduction Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
  2. 2Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  3. 2Department of Population Health, University of
  4. 3Kansas Medical Center, Kansas City, KS, USA
  5. 4Department of Surgery, New York University Langone Health, Bellevue Hospital, New York, NY, USA
  6. 5Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
  7. 6Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
  8. 7Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
  9. 8Breakfast Club, Florissant, MO, USA
  10. 9Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
  11. 10Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
  12. 11Centre Universitaire de Médecine Générale Et Santé Publique, Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
  13. 12UMR 1295, CERPOP, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France


Introduction To implement effective conversation aids for early-stage breast cancer surgery, we introduced an online learning collaborative, SHAIR Collaborative, targeting clinical teams who treat these patients. In this qualitative study, we explored factors impacting conversation aid implementation and participation in SHAIR.

Methods Using an interview guide designed using Diffusion of Innovation theory,1 we are conducting two rounds of semi-structured interviews with a purposive sample of SHAIR clinicians and staff during implementation and toward the end of implementation/sustainability of the conversation aids at sites. Two independent coders are performing thematic analysis of interview transcripts guided by Diffusion of Innovation facilitators.

Results We completed the first round of interviews (n=12) across the U.S. and Mexico, involving ten surgeons and two staff. SHAIR was deemed easy to engage with (complexity) and was used by surgeons to access conversation aids (compatibility). Adoption/Use of conversation aids was easier for surgeons who previously used pre-printed materials and/or drew pictures during patient encounters (compatibility). Conversation aids were viewed as beneficial in facilitating more productive and structured conversations (relative advantage). Patients appreciated a physical document to bring home and review later (observability). Identifying eligible patients and maintaining conversation aid supplies integrated well into surgeons’ workflow without increasing burden (compatibility). The largest barrier to implementation was surgeons’ unwillingness to stray from their usual discussion with patients (compatibility). The second round of interviews will be completed in Spring 2024. Final results will be available in June 2024.

Discussion Clinicians found the online learning collaborative easy to engage with and a valuable facilitator for shared decision making. Integration into workflows highlighted compatibility, but resistance to change emerged as a notable barrier.

Conclusion Many factors impact participation in SHAIR and subsequent conversation aid implementation. This study will inform future implementation of learning collaboratives.

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.


  1. Rogers EM. Diffusion of Innovations. 1995; New York: Free Press, 4th Edition.

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