D B Raphael Daniela1,2,3, N S Russell3, E van Werkhoven4, J M Immink5,6, D P G Westhoff7, M C Stenfert Kroese8, M R Stam9, L M van Maurik10, C M J van Gestel11, T van der Weijden2, L J Boersma12. 1. Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands. 2. Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. 3. Department of Radiotherapy, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands. 4. Department of Biometrics, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands. 5. Department of Radiation Oncology, Reinier de Graaf Hospital, Delft, The Netherlands. 6. Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. 8. Radiotherapy Group, Deventer, The Netherlands. 9. Radiotherapy Group, Arnhem, The Netherlands. 10. Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands. 11. Southwest Radiotherapy Institute, Roosendaal, The Netherlands. 12. 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.
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.
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 cancerpatients, 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.
Entities:
Keywords:
Breast irradiation; Implementation; Patient decision aid; Shared decision-making
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