Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams

Haske van Veenendaal*, Helene R. Voogdt-Pruis, Dirk T. Ubbink, Esther van Weele, Lejla Koco, Maaike Schuurman, Jannie Oskam, Ella Visserman, Carina G.J.M. Hilders

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the ‘Measurement Instrument for Determinants of Innovations-model’ (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.

Original languageEnglish
Pages (from-to)114-127
Number of pages14
JournalPatient Education and Counseling
Volume105
Issue number1
DOIs
Publication statusAccepted/In press - 11 May 2021

Bibliographical note

Funding Information:
An unrestricted educational grant was provided by Zilveren Kruis Healthcare Insurance Company and the Dutch Ministry of Health , Grant Number is Z670 . Welfare and Sport. In-kind support was provided by the participating hospitals.

Publisher Copyright:
© 2021 The Authors

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