W Savelberg1, L J Boersma2, M Smidt3, M F J Goossens4, R Hermanns5, T van der Weijden6. 1. Department of Quality and Safety, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: w.savelberg@mumc.nl. 2. Oncology Centre, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; Maastricht University Medical Centre, Department of Radiotherapy (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands. Electronic address: liesbeth.boersma@maastro.nl. 3. Oncology Centre, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: m.smidt@mumc.nl. 4. Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands. Electronic address: medi.goossens@student.maastrichtuniversity.nl. 5. Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands. Electronic address: raoul.hermanns@student.maastrichtuniversity.nl. 6. School CAPHRI, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands; Department of Family Medicine, Maastricht University, Debeyeplein 1, 6229 ER, Maastricht, the Netherlands. Electronic address: trudy.vanderweijden@maastrichtuniversity.nl.
Abstract
PURPOSE: Although most of the clinicians in breast cancer care seem to approve of shared decision making (SDM), actual implementation is limited. The aim of this study was to explore the experiences, issues and concerns of early-adopter professionals with regards to shared decision making. METHODS: This qualitative descriptive study was part of a pilot study aimed at implementing SDM in breast cancer teams. We interviewed 27 clinicians; 9 breast cancer surgeons, 11 nurse practitioners and 7 nurses. The teams were exposed to a multifaceted implementation programme, among others: a patient decision aid (PtDA), a procedure to disseminate the PtDA and advice on redesigning the clinical pathway. RESULTS: Participants considered SDM, including the delivery of the PtDA, to be a team effort, in which every professional should take responsibility. Most clinicians primarily focused on the first steps of SDM ignoring preference and decision talk. The remaining steps, like the uptake of the PtDA in the clinical pathway, were regarded as challenging, with surgeons, intentionally or unconsciously, delegating this responsibility to nurses. One barrier to successfully implementing SDM seems to lie in the fact that clinicians were unaware of their lack of competency regarding SDM. CONCLUSIONS: A deeper understanding is needed among clinicians of what SDM actually is and how a PtDA contributes to this process. Nurses play an important role in the delivery of the PtDA, but their role is not clearly defined. Teams should consider a clear realignment of tasks between surgeons and nurses, which implies redesign of the pathway.
PURPOSE: Although most of the clinicians in breast cancer care seem to approve of shared decision making (SDM), actual implementation is limited. The aim of this study was to explore the experiences, issues and concerns of early-adopter professionals with regards to shared decision making. METHODS: This qualitative descriptive study was part of a pilot study aimed at implementing SDM in breast cancer teams. We interviewed 27 clinicians; 9 breast cancer surgeons, 11 nurse practitioners and 7 nurses. The teams were exposed to a multifaceted implementation programme, among others: a patient decision aid (PtDA), a procedure to disseminate the PtDA and advice on redesigning the clinical pathway. RESULTS:Participants considered SDM, including the delivery of the PtDA, to be a team effort, in which every professional should take responsibility. Most clinicians primarily focused on the first steps of SDM ignoring preference and decision talk. The remaining steps, like the uptake of the PtDA in the clinical pathway, were regarded as challenging, with surgeons, intentionally or unconsciously, delegating this responsibility to nurses. One barrier to successfully implementing SDM seems to lie in the fact that clinicians were unaware of their lack of competency regarding SDM. CONCLUSIONS: A deeper understanding is needed among clinicians of what SDM actually is and how a PtDA contributes to this process. Nurses play an important role in the delivery of the PtDA, but their role is not clearly defined. Teams should consider a clear realignment of tasks between surgeons and nurses, which implies redesign of the pathway.
Authors: Ellen M Driever; Ivo M Tolhuizen; Robbert J Duvivier; Anne M Stiggelbout; Paul L P Brand Journal: BMC Med Educ Date: 2022-03-08 Impact factor: 2.463
Authors: D B Raphael Daniela; N S Russell; E van Werkhoven; J M Immink; D P G Westhoff; M C Stenfert Kroese; M R Stam; L M van Maurik; C M J van Gestel; T van der Weijden; L J Boersma Journal: Breast Cancer Res Treat Date: 2020-10-24 Impact factor: 4.872