Implementing a patient decision aid, a process evaluation of a large-scale pre- and post-implementation trial
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CLINICAL TRIAL
Implementing a patient decision aid, a process evaluation of a large‑scale pre‑ and post‑implementation trial D. B. Raphael Daniela1,2,3 · N. S. Russell3 · E. van Werkhoven4 · J. M. Immink5,6 · D. P. G. Westhoff7 · M. C. Stenfert Kroese8 · M. R. Stam9 · L. M. van Maurik10 · C. M. J. van Gestel11 · T. van der Weijden2 · L. J. Boersma1 Received: 2 September 2020 / Accepted: 8 October 2020 © The Author(s) 2020
Abstract Purpose Patient decision aids (PtDAs) have been reported to have a positive influence on patients making a health care decision in trials. Nevertheless, post-trial implementation is poor. The aim of this study is to explore patient, clinician, and organizational success factors for implementing a PtDA designed for breast cancer patients, facing a decision on their radiation treatment. Methods We performed a process evaluation within a multi-center pre- and post-implementation trial. The PtDA was incorporated as much as possible in the logistics of 13 participating centers. Tracking data were collected on PtDA use. Process characteristics were recorded by both clinicians and patients. A logistic regression method was applied to investigate which process characteristics were significantly related to the probability that patients logged in to the PtDA. Results 189 patients received the PtDA of whom140 (77%) used the PtDA. If patients received the link via the surgery department they were more likely to use the PtDA (OR 9.77 (1.28–74.51)), compared to patients that received the link via the radiation oncology department. If the report of the multidisciplinary team stated that radiation treatment “had to be discussed with the patient”, patients were more likely to use the PtDA (OR 2.29 (1.12–4.71)). Educational level was not related to the probability of PtDA use. Conclusions We accomplished a high level of PtDA use. Patients were more likely to use the PtDA if they received the link via the surgery department and if “to be discussed with the patient” was written in the multidisciplinary team report. Keywords Patient decision aid · Implementation · Breast irradiation · Shared decision-making Abbreviations PtDA Patient decision aid MDT Multidisciplinary team RT Radiation treatment SDM Shared decision-making CFIR Consolidated framework for implementation research CRF Case report form
Work presented at: EACH, Leiden, The Netherlands, September 2019. * L. J. Boersma [email protected] Extended author information available on the last page of the article
Introduction Patient decision aids (PtDA) have been found to support the process of shared decision-making (SDM) [1–4]. In a review of 105 randomized clinical trials, Stacey et al. found that PtDAs improve quality of the decision-making process, lower decisional conflict and improve patient-clinician communication, without causing any harm [5, 6]. Despite these positive effects in clinical trials, PtDAs facilitating SDM have not been widely implemented in medical practice [7, 8]. Stacey et al. found a low uptake of PtDAs a
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