Implementing a patient decision aid, a process evaluation of a large-scale pre- and post-implementation trial

Breast Cancer Research and Treatment, vol. 185, pp. 685–695

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.

Authors 11

1. D.B. Raphael

   Maastricht University Medical Centre · The Netherlands Cancer Institute · Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

   Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands

   Department of Radiotherapy, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands

2. Nicola S. Russell

   The Netherlands Cancer Institute

   Affiliation as printed

   Department of Radiotherapy, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands

3. Erik D. van Werkhoven

   The Netherlands Cancer Institute

   Affiliation as printed

   Department of Biometrics, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands

4. J.M. Immink Aachen Department of Radiation Oncology

   Leiden University Medical Center · Reinier de Graaf Hospital

   Affiliation as printed

   Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

   Department of Radiation Oncology, Reinier de Graaf Hospital, Delft, The Netherlands

5. D. P. G. Westhoff

   Radboud University Medical Center

   Affiliation as printed

   Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands

6. Marika C. Stenfert Kroese
   Affiliation as printed

   Radiotherapy Group, Deventer, The Netherlands

7. Marcel R. Stam

   Radiotherapiegroep

   Affiliation as printed

   Radiotherapy Group, Arnhem, The Netherlands

8. Lisette M. van Maurik

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

9. Cornelia M.J. van Gestel
   Affiliation as printed

   Southwest Radiotherapy Institute, Roosendaal, The Netherlands

10. Trudy van der Weijden

    Maastricht University · Care and Public Health Research Institute

    Affiliation as printed

    Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

11. Liesbeth Jorinne Boersma corresponding

    Maastricht University Medical Centre · Maastricht University

    Affiliation as printed

    Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands. liesbeth.boersma@maastro.nl

    Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands