Shared decision-making supported by outcome information regarding surveillance after curative treatment for breast cancer: Results of the SHOUT-BC study
European Journal of Cancer, vol. 213, pp. 115107
Abstract
BACKGROUND: Integrating outcome information into the process of shared decision-making (SDM) about post-treatment surveillance can enhance its effectiveness. The Breast Cancer Surveillance Decision Aid (BCS-PtDA) integrates risk estimations of patients' risks for recurrences as well as outcome information on fear of cancer recurrence (FCR). The SHOUT-BC study aimed to evaluate the effectiveness of the implementation of the BCS-PtDA. Patients' satisfaction with the BCS-PtDA was also evaluated. METHODS: As described in a previously published protocol paper, the study employed a Prospective multiple interrupted time series (ITS) design in which the BCS-PtDA was implemented stepwise into the care pathways of eight Dutch hospitals. RESULTS: A total of 507 participants completed a questionnaire after their first surveillance consultation which usually takes place approximately one year after surgery. ITS analysis per hospital and subsequent meta-analysis over hospital effects indicated a significant increase in patient-reported SDM from pre- to post-implementation (overall estimated effect: 27.14, 95 % CI: 22.71 to 31.87, p < .0001). Moreover, post-implementation participants (n = 225) reported a more active role in decision-making, decreased decisional conflict, and increased knowledge on the aim and methods of surveillance. Furthermore, a decrease in FCR was seen post-implementation. The self-reported intensity of surveillance schedules decreased slightly and the BCS-PtDA received highly positive evaluations. DISCUSSION: The implementation of the BCS-PtDA, which integrates outcome information, led to increased patient-reported SDM and an improved quality of decision-making. The BCS-PtDA was evaluated highly positively by participants. Further research should address optimisation of the implementation.
Authors 11
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Jet Wies Ankersmid corresponding
Santeon (Netherlands) · University of Twente
Affiliation as printed
University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands; Santeon, Utrecht, the Netherlands. Electronic address: j.w.ankersmid@utwente.nl
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Affiliation as printed
University of Twente, Department of Psychology, Health & Technology, Enschede, the Netherlands
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Canisius-Wilhelmina Ziekenhuis
Affiliation as printed
Canisius Wilhelmina Hospital, Department of Surgery, Nijmegen, the Netherlands
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Affiliation as printed
Santeon, Utrecht, the Netherlands
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Noel Engels Aachen
Leiden University · Leiden University Medical Center · Maasstad Ziekenhuis
Affiliation as printed
Santeon, Utrecht, the Netherlands; Maasstad Hospital, Department of Internal Medicine, Rotterdam, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands
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Affiliation as printed
Santeon, Utrecht, the Netherlands; OLVG, Department of Neurology, Amsterdam, the Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Research Institute for Medical Innovation, Science Department IQ Health, Section Biostatistics, Nijmegen, the Netherlands
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Affiliation as printed
Catharina Hospital, Department of Surgery, Eindhoven, the Netherlands
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Affiliation as printed
ZorgKeuzeLab, Delft, the Netherlands
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Affiliation as printed
Santeon, Utrecht, the Netherlands
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Netherlands Comprehensive Cancer Organisation · University of Twente
Affiliation as printed
University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands
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