Abstract
PurposeShared decision-making is currently not widely implemented in breast cancer care. Encounter decision aids support shared decision-making by helping patients and physicians compare treatment options. So far, little was known about adaptation needs for translated encounter decision aids, and encounter decision aids for breast cancer treatments were not available in Germany. This study aimed to adapt and evaluate the implementation of two encounter decision aids on breast cancer treatments in routine care.MethodsWe conducted a multi-phase qualitative study: (1) translation of two breast cancer Option Grid™ decision aids; comparison to national clinical standards; cognitive interviews to test patients’ understanding; (2) focus groups to assess acceptability; (3) testing in routine care using participant observation. Data were analysed using qualitative content analysis.ResultsPhysicians and patients reacted positively to the idea of encounter decision aids, and reported being interested in using them; patients were most receptive. Several adaptation cycles were necessary. Uncertainty about feasibility of using encounter decision aids in clinical settings was the main physician-reported barrier. During real-world testing (N = 77 encounters), physicians used encounter decision aids in one-third of potentially relevant encounters. However, they did not use the encounter decision aids to stimulate dialogue, which is contrary to their original scope and purpose.ConclusionsThe idea of using encounter decision aids was welcomed, but more by patients than by physicians. Adaptation was a complex process and required resources. Clinicians did not follow suggested strategies for using encounter decision aids. Our study indicates that production of encounter decision aids alone will not lead to successful implementation, and has to be accompanied by training of health care providers.
Highlights
In breast cancer treatment, patients and physicians have to make several decisions regarding treatment options that might considerably affect patients’ quality of life and other person-centred health outcomes
It was necessary to adapt, so the content would match the current state of breast cancer care delivery in Germany
A few changes in the Decision aids (DAs) were made to reflect the results of the cognitive interviews and additional results from focus group discussions
Summary
Patients and physicians have to make several decisions regarding treatment options that might considerably affect patients’ quality of life and other person-centred health outcomes. With many new emerging treatment options, this process has become more complex and challenging for patients and physicians over the last years It is, important to take patients’ preferences and values into account [1, 2]. The aim is for both parties to be actively involved and come to a shared and informed treatment decision based on the available clinical evidence and the patient’s individual preferences and values [8]. Within this process, the physician supports the patient to weigh the benefits and risks as well as possible consequences of different treatment options [9]. Since patients and physicians appraise the quality of different treatment options differently [10], it is important to encourage a dialogue and come to a shared understanding of what the best option for the individual patient is
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
