DOI: 10.5061/dryad.hmgqnk9jg
title: DECIDO-professionals-barriers-facilitators

description: This study explored the barriers and facilitators to the implementation of
 a risk-based breast cancer screening program from the point of view of
 Spanish health professionals. A cross-sectional study with 220 Spanish
 health professionals was designed. Data were collected in 2020 via a
 web-based survey and included advantages and disadvantages of risk-based
 screening and barriers and facilitators for the implementation of the
 program. Descriptive statistics and Likert scale responses analyzed as
 category-ordered data were obtained. Risk-based screening was considered
 important or very important to reduce breast cancer mortality and promote
 a more proactive role for women in breast cancer prevention, to increase
 coverage for women under 50 years, to promote a breast cancer prevention
 strategy for women at high risk and to increase efficiency and
 effectiveness. Switching to a risk-based program from an age-based program
 was rated as important or very important by 85% of participants. As
 barriers for implementation, risk communication, workload of health
 professionals and limited human and financial resources were mentioned.
 Despite the barriers, there is good acceptance and it seems feasible, from
 the perspective of health professionals, to implement a risk-based breast
 cancer screening program in Spain. However, this poses a number of
 organizational and resource challenges.
description: We conducted an exploratory
 cross-sectional study with health professionals whose work was or was not
 directly related to breast cancer screening. Our research team contacted
 and presented the study to the board of directors of several Catalan and
 Spanish health related societies and scientific groups (public health,
 family and community medicine, and breast specialists). We asked them to
 invite the society or group members to participate in the study which
 consisted of responding to a questionnaire with an estimated completion
 time of 20 minutes. The study information and the link to the
 questionnaire were posted in the scientific societies' web pages or
 newsletters. For data
 protection reasons, we did not have information on the number of potential
 participants, or their demographic or job characteristics Therefore, a
 self-selection sampling method where individuals choose to take part in
 research on their own accord, was used.
 Data were collected between
 July and November of 2020, using a web-based survey. The questionnaire was
 built on the Typeform platform (https://www.typeform.com/) in the Spanish and Catalan languages. A pilot test with a convenience sample of 20 participants was conducted and some changes were made based on their suggestions.  A survey sample size of 210 professionals was chosen as appropriate so that 95% confidence intervals of the true proportion responding positively would be approximately 7% either side of the observed proportion. We closed the data collection when 220 health professionals had completed the survey. Sociodemographic data: age, gender, professional field (nurse, doctor, other), medical specialty or professional profile, years of practice, type of work center (public, private, both, university, other), type of relationship or employment contract, and work relation with early detection of breast cancer (yes/no); Advantages of risk-based screening for the health of women with an individual risk of breast cancer higher (6 items) /lower (6 items) than the population average; Disadvantages of risk-based screening for women’s health (6 items); Advantages of risk-based screening, in relation to current screening, for the Spanish National Health System (4 items); Barriers (15 items) and facilitators (6 items) for the implementation of risk-based screening; Implementation of shared decision-making in breast cancer screening (12 items); Aspects of the organizational structure to consider for the implementation of a risk-based screening program (9 items); Communication of the benefits and harms of breast cancer screening (7 items); Coordination of the risk-based screening program (3 items); Except sociodemographic data, all items were scored on 5-point Likert scales. For the first six sections of the questionnaire, related to the risk-based program, the importance given to the statements was assessed as: 1-unimportant, 2-slightly important, 3-moderately important, 4-important, and 5-very important. For the last two sections -communication of the benefits and harms and coordination of the risk-based screening program-, the level of agreement given to the statements was assessed as: 1-strongly disagree, 2-disagree, 3-undecided, 4-agree, 5-strongly agree. In addition, the survey included these two questions: Considering the advantages and disadvantages, how important is it for you to move from the current Screening Program to a personalized Breast Cancer Screening Program? Answer: 1 to 5 Likert scale, where 1-very little or nothing and 5-a lot; Given the current Breast Cancer Screening Program, do you think Primary Care should be the gateway to a future personalized breast cancer screening program? Answer: Yes/No.