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Implementing decision aid use and shared-decision making in breast cancer screening: A scoping review
Rama Alkhaldi1, Neha Pathak2, Victoria Mintsopoulos3
1School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Objectives:
International guidelines vary regarding the age range for mammography screening for women at average breast cancer risk; however, all note the importance of shared-decision making (SDM). Decision Aids (DAs) are evidence-based materials demonstrated to facilitate SDM and improve decisional conflict. The integration of SDM/DA is crucial to support patient-informed choice; however, little is known related to their implementation to clinical practice.
Methods:
This scoping review searched nine bibliographic databases from January 2010 to May 2023.
Inclusion Criteria:
studies targeting providers and/or women at average risk of developing breast cancer, implementing SDM and/or DA regarding breast cancer screening, and must include at least one implementation outcome. Data were extracted on study design, intervention details, primary outcome, and all implementation outcomes. Studies were coded as efficacy, effectiveness, or implementation. Implementation strategies were coded using Expert Recommendations for Implementing Change (ERIC) and strategies used to change clinical behaviors were coded using Behavior Change Techniques (BCTs) taxonomy.
Results:
The search yielded 10,383 records: 22 studies met the inclusion criteria, 2 targeting providers, 16 targeting patients, and 4 targeting both. Studies were classified as follows (provider cohort; patient cohort): efficacy (0/6,0 %; 8/20,40 %), effectiveness (4/6,67 %; 10/20,50 %), and primary implementation (1/6,17 %; 1/20,5 %). In the provider cohort, acceptability was assessed in 6/6(100 %), adoption in 2/6(33 %), feasibility in 2/6(33 %), appropriateness and sustainability in 1/6(17 %). In the patient cohort, acceptability was assessed in 20/20(100 %), feasibility in 3/20(15 %), appropriateness in 3/20(15 %), adoption in 1/20(5 %). DAs demonstrated moderate-to-excellent acceptability. BCTs commonly employed include shaping knowledge, natural consequences, and comparison of outcomes. Implementation strategies frequently used include developing and distributing educational materials.
Practice Implications:
SDM/DAs appear acceptable to patients and providers; however, these tools can only help if they are used as intended. More primary implementation studies, to evaluate and understand the optimal strategies for implementation of SDM/DA in these healthcare settings.
