Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population and Selection
2.3. Ethical Approval
2.4. Implementation Program
2.5. Data Collection
2.6. Sample Size Calculation
2.7. Statistical Analysis
3. Results
3.1. Participants
3.1.1. Hospital Teams
3.1.2. Patients
3.2. Characteristics of Consultations
3.3. SDM Adoption by Clinicians
3.4. Perception of Patients
3.5. Correlated Variables
3.6. Program Components (Working Mechanisms)
3.7. Key Consultation Features: Duration, Discussed Options and Decisions Made
4. Discussion
4.1. Discussion of Results
4.2. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participation in Team Training | Care Pathway Redesign, Decision Tool Used, Coordinator Appointed | Reallocation of Tasks/ E-Learning | Participation Clinicians in 2 Collaborative Meetings (N) | Patients Involved | Discussed Feedback from Consultations (N before; N after) | |
---|---|---|---|---|---|---|
Team 1 | Yes | Yes | No | Yes (2) | Yes | Yes (14;15) |
Team 2 | Yes | No | No | No (0) | No | Yes (9;9) |
Team 3 | Yes | No | No | Yes (4) | Yes | Yes (9;2) |
Team 4 | Yes | Yes | Yes | Yes (3) | Yes | Yes (16;15) |
Team 5 | Yes | No | No | Yes (2) | Yes | Yes (15;8) |
Pre- Implementation | Post- Implementation | Difference (p-Value) (95%CI) | |
---|---|---|---|
1. Option-5 scores (SD) (N) | |||
Hospital team 1 | 26.4 (11.0) (14) | 58.0 (17.0) (15) | +31.6 (<0.001) (20.6 to 42.6) |
Hospital team 2 | 28.9 (10.8) (9) | 50.0 (12.2 (9) | +21.1 (<0.001) (9.6 to 32.7) |
Hospital team 3 | 45.6 (13.8) (9) | 52.5 (3.5) (2) | +6.9 (0.51) (−16.1 to 30.0) |
Hospital team 4 | 43.8 (13.1) (16) | 65.7 (21.4) (15) | +21.9 (0.002) (9.0 to 34.8) |
Hospital team 5 | 26.3 (12.9) (15) | 31.3 (11.3) (8) | +5.0 (0.37) (−6.3 to 16.2) |
Total (N = 112) | 33.9 (14.8) (63) | 54.3 (19.9) (49) | +20.4 (<.001) (13.6 to 27.2) |
2. Total SDM-Q-9 scores | |||
Median (IQR) (N = 74) | 91.1 (82.2−100.0) (51) | 88.9 (82.2−100.0) (23) | −2.2 (0.81) |
3. Consultation duration | |||
Median min:sec (IQR) (N) | 36:00 (24.0−70.0) (63) | 40:00 (25.0–77.0) (49) | +04:00 (0.74) |
4. Number of consultations | |||
1 per patient (%) | 31 (49.2%) | 24 (49.0%) | −0.2% (.98) (−17.8 to 18.2) |
>1 per patient (%) | 32 (50.8%) | 25 (51.0%) | +0.2% (.98) (−17.8 to 18.2) |
5. N of options offered | |||
1 option (%) | 23.3% (14) | 10.2% (5) | −13.1% |
2 options (%) | 60.0% (36) | 53.1% (26) | −6.9% |
3 options (%) | 15.0% (9) | 6.1% (3) | −8.9% |
4 options (%) | 1.7% (1) | 30.6% (15) | +28.9% |
Total mean | 1.95% (60) | 2.57% (49) | +0.62% (p < 0.001) (0.28 to 0.96) |
6. Type of option offered | |||
Active surveillance | 68.3% (41) | 81.6% (40) | +13.3% (0.11) (−3.3 to 28.4) |
Chemotherapy | 50.0% (30) | 67.3% (33) | +17.3% (0.07) (−1.2 to 34.1) |
Hormone therapy | 61.7% (37) | 59.2% (29) | −2.5% (0.79) (−20.4 to 15.4) |
Chemo/targeted therapy | 11.7% (7) | 12.2% (6) | +0.5% (0.93) (−11.8 to 14.0) |
Chemo/hormone therapy | 1.7% (1) | 32.7% (16) | +31% (p < 0.001) (17.5 to 45.0) |
Hormone/chemo/targeted therapy | 1.7% (1) | 4.1% (2) | +2.4% (0.44) (−5.4 to 12.1) |
No decision yet | 1.7% (1) | 0.0% (0) | −1.7% (0.36) (−8.9 to 5.7) |
7. Chosen options | |||
Conservative treatment | 9.8% (5) | 8.2% (4) | −1.6% (0.77) (−13.9 to 10.7) |
Chemotherapy | 29.4% (15) | 28.6% (14) | −0.8% (0.93) (−18.2 to 16.7) |
Hormone therapy | 39.2% (20) | 30.6% (15) | −8.6% (0.37) (−26.2 to 9.9) |
Chemo/targeted therapy | 13.7% (7) | 8.2% (4) | −5.5% (0.37) (−18.5 to 7.5) |
Chemo/hormone therapy | 3.9% (2) | 14,3% (7) | +10.4% (0.07) (−1.4 to 23.1) |
Hormone/chemo/targeted therapy | 0.0% (0) | 2.0% (1) | +2.0% (0.31) (−5.2 to 10.7) |
No decision yet | 3.9% (2) | 8.2% (4) | +4.3% (0.37) (−6.3 to 15.6) |
β-Coefficient * (95% CI) | p-Value | |
---|---|---|
Independent variables | ||
1. Hospital team | ||
Team 1 | reference | |
Team 2 | −4.2 (−16.8 to 8.4) | 0.51 |
Team 3 | 7.7 (−4.0 to 19.3) | 0.19 |
Team 4 | −4.0 (−18.0 to 9.9) | 0.57 |
Team 5 | −10.9 (−21.8 to 0.12) | 0.053 |
2. Type of clinician | ||
Medical oncologist | reference | |
Nurse specialist | 10.2 (−6.7 to 27,1) | 0.24 |
Oncology surgeon | 10.4 (−6.3 to 27.0) | 0.22 |
3. Number of discussed options | ||
1 option | reference | |
2 options | 10.2 (2.7 to 17.6) | 0.008 |
>2 options | 14.4 (4.2 to 24.6) | 0.006 |
4. Consultation duration | ||
<25 minutes | reference | |
25–45 minutes | 3.3 (−5.3 to 11.8) | 0.45 |
>45 minutes | 6.5 (−3.7 to 16.7) | 0.21 |
5. Exposure to implementation program | ||
No exposure (0 activities) | reference | |
Median exposure (1–5 activities) | 13.1 (4.9 to 21.3) | 0.002 |
High exposure (6–10 activities) | 19.6 (11.9 to 27.3) | <0.001 |
β-Coefficient * (95% CI) | p-Value | |
---|---|---|
Independent variables | ||
1. Completion E-learning and reallocation of tasks | ||
Not carried out | reference | |
Carried out | 11.4 (0.31 to 22.5) | 0.044 |
2. Use of decision tool, adjustment of care pathway and appointment of a coordinator | ||
Not carried out | reference | |
Carried out | 6.0 (−5.3 to 17.3) | 0.30 |
3. Having discussed feedback from consultations | ||
No participation | reference | |
Participation | 18.7 (10.0 to 27.4) | <0.001 |
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van Veenendaal, H.; Peters, L.J.; van Weele, E.; Hendriks, M.P.; Schuurman, M.; Visserman, E.; Hilders, C.G.J.M.; Ubbink, D.T. Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer. Curr. Oncol. 2023, 30, 236-249. https://doi.org/10.3390/curroncol30010019
van Veenendaal H, Peters LJ, van Weele E, Hendriks MP, Schuurman M, Visserman E, Hilders CGJM, Ubbink DT. Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer. Current Oncology. 2023; 30(1):236-249. https://doi.org/10.3390/curroncol30010019
Chicago/Turabian Stylevan Veenendaal, Haske, Loes J. Peters, Esther van Weele, Mathijs P. Hendriks, Maaike Schuurman, Ella Visserman, Carina G. J. M. Hilders, and Dirk T. Ubbink. 2023. "Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer" Current Oncology 30, no. 1: 236-249. https://doi.org/10.3390/curroncol30010019