Abstract
BackgroundDecision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic.MethodsFrom July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions.ResultsReach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80 %); coached 1,110 (73 %) in the self-administered use of decision and communication aids; sent 958 (63 %) decision aids; and directly administered communication aids for 419 (27 %) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81 % of visitsEffectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfactionAdoption: Among visitors sent decision aids, 82 % of survey respondents reviewed some or all; among those administered communication aids, 86 % reviewed one or more after the visitImplementation: Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29 % in 2005 to 84 % in 2012Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by testing a service learning model in which student interns work as program coaches in exchange for academic credit rather than salary. The feasibility test succeeded, and we are now expanding the use of unpaid interns.ConclusionWe have sustained a clinic-wide implementation of decision and communication aids through a novel staffing model that uses paid and unpaid student interns as coaches.
Highlights
Decision aids educate patients about treatment options and outcomes
We obtained a waiver of written consent and ethics approval from the UCSF Committee on Human Research to abstract and de-identify our program records for research analysis and reporting purposes. In this manuscript we report on data not previously published, while summarizing data reported in earlier publications [8, 14, 15, 20, 25,26,27,28,29]
Over the study period (2005 to 2012), our staff sent a grand total of 5,153 decision aids and directly administered 2,004 communication aids
Summary
Communication aids include question lists, consultation summaries, and audio-recordings. Decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic. Participating in breast cancer treatment decisions is often difficult for patients because the diagnosis is a shock and throws many patients into cognitive and emotional overload. When physicians do answer patient questions, the information “goes in one ear and out the other.” [2] Evidence based interventions such as decision aids and communication aids have emerged to help patients meet these decision making and communication needs [3,4,5] At the appointment, patients often “freeze up and forget to ask questions.” When physicians do answer patient questions, the information “goes in one ear and out the other.” [2] Evidence based interventions such as decision aids and communication aids have emerged to help patients meet these decision making and communication needs [3,4,5]
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