Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer

Haske van Veenendaal*, Loes J. Peters, Esther van Weele, Mathijs P. Hendriks, Maaike Schuurman, Ella Visserman, Carina G.J.M. Hilders, Dirk T. Ubbink

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Enhancing the application of shared decision-making (SDM) is critical for integrating patient preferences in breast cancer treatment choices. We investigated the effect of an adapted multilevel SDM implementation program in breast cancer care. Methods: Breast cancer patients qualifying for (neo)adjuvant systemic treatment were included in a multicenter before–after study. Consultations were audio recorded between June 2018 and July 2019 and analyzed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to score SDM application by clinicians. The Shared Decision-Making Questionnaire (SDM-Q-9) was used to rate patients’ perceived SDM level. Consultation duration, decision types, number of options discussed and consultations per patient were monitored. Regression analysis was used to investigate the correlated variables and program components. Results: Mean OPTION-5 scores increased from 33.9 (n = 63) before implementation to 54.3 (n = 49) after implementation (p < 0.001). The SDM-Q-9 scores did not change: 91.1 (n = 51) at baseline versus 88.9 (n = 23) after implementation (p = 0.81). Without increasing consultation time, clinicians discussed more options after implementation. The regression analysis showed that exposure to the implementation program, redistribution of tasks and discussing feedback from consultations was associated with a higher level of SDM. Conclusion: The multilevel program helped clinicians achieve clinically relevant improvement in SDM, especially when it is tailored to (individuals in) teams and includes (e-)training, discussing feedback on consultations and redistribution of tasks.

Original languageEnglish
Pages (from-to)236-249
Number of pages14
JournalCurrent Oncology
Volume30
Issue number1
DOIs
Publication statusPublished - Jan 2023

Bibliographical note

Funding Information:
This research was funded with unrestricted educational grants by Zilveren Kruis Healthcare Insurance Company (grant number not applicable) and the Dutch Ministry of Health, Welfare and Sport (grant number not applicable). In-kind support was provided by the participating hospitals. Additional information can be obtained from the corresponding author on request.

Publisher Copyright: © 2022 by the authors.

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