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

Area of Science:

• Oncology
• Health Services Research
• Patient Decision Making

Background:

• Patient decision aids (PtDAs) show promise in clinical trials for improving healthcare choices.
• However, successful implementation of PtDAs into routine clinical practice remains a challenge.
• This study focuses on breast cancer patients deciding on radiation treatment.

Purpose of the Study:

• To identify patient, clinician, and organizational factors influencing the implementation of a breast cancer radiation treatment decision aid.
• To explore success factors for integrating PtDAs into clinical workflows.

Main Methods:

• A multi-center pre- and post-implementation trial incorporating a process evaluation.
• Data collection included PtDA usage tracking and clinician/patient-reported process characteristics.
• Logistic regression analysis identified factors associated with patient PtDA login probability.

Main Results:

• Out of 189 patients receiving the PtDA, 140 (77%) used it.
• PtDA use was significantly higher when links were provided by the surgery department (OR 9.77) compared to radiation oncology.
• Patients were more likely to use the PtDA if the multidisciplinary team report indicated discussion was necessary (OR 2.29).
• Educational level did not correlate with PtDA usage.

Conclusions:

• A high level of patient decision aid use was achieved in this implementation study.
• Key factors for increased PtDA engagement included receiving the link via the surgery department and explicit recommendations for discussion from multidisciplinary teams.