Implementation of a Web-based Decision Aid for Breast Cancer Surgery
Condition: Breast Cancer; Surgery
MeSH terms: Breast Neoplasms
Study type: Observational

Summary: 
      Routine incorporation of decision aids into oncology practice has the potential to
      significantly improve patients' experiences with cancer by increasing the likelihood that
      they make informed treatment decisions aligned with their values. Unfortunately, only a
      minority of the more than 1.6 million patients diagnosed annually with cancer ever receive
      one due to limited clinic resources for administration and challenges in timely
      identification of appropriate patients. Online delivery directly to patients addresses some
      of these barriers but is insufficient on its own to ensure accessibility for patients at the
      time they most benefit from support.19 It is critical that active, multi-faceted
      implementation strategies that target barriers to the widespread use of web-based decision
      aids be identified, as these tools have the potential to significantly improve the quality of
      oncologic care.

      Based on strong preliminary work, the investigators have developed and piloted a package of
      implementation strategies that effectively overcomes barriers to delivery of a web-based
      breast cancer surgery decision aid in an academic and community clinic. Although the strategy
      was successful, patients were white and educated; further investigation is imperative in
      settings that provide care to underserved patients to ensure the intervention will mitigate,
      rather than worsen, existing disparities in breast cancer care. This is especially critical
      given that underserved patients may benefit most from shared decision-making interventions
      such as the one described. To study this, the investigators propose a pilot study within a
      clinic that serves a catchment area with a high proportion of African American, rural and low
      income patients. The investigators will iteratively assess and enhance our implementation
      package using concepts outlined in the Knowledge-to-Action Cycle, which emphasizes local
      context in balancing fidelity and flexibility. The specific aims are: 1) To identify patient
      and clinic level barriers to implementation of a web-based breast cancer surgery decision aid
      in a clinic that cares for underserved patients, and 2) To test and expand our current
      implementation package's ability to address barriers in a clinic that cares for underserved
      patients. The investigators will determine the reach of implementation and acceptability of
      this method of decision aid delivery to stakeholders.
    


Intervention name(s): Breast Cancer Surgery Decision Aid
Intervention type(s): Other
Intervention description(s): We use a standard decision aid collaboratively developed by Health Dialog and the Informed Medical Decisions Foundation
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        This is a clinic-level intervention with two stakeholder groups: (1) clinical staff, clinic
        leadership, and surgeons involved in implementation, and (2) patients newly diagnosed with
        Stage 0-3 breast cancer.