Feasibility of Providing Web-Based Information to Breast Cancer Patients Prior to a Surgical Consult

Abstract

Patients facing decisions for breast cancer surgery commonly search the internet. Directing patients to high-quality websites prior to the surgeon consultation may be one way of supporting patients' informational needs. The objective was to test an approach for delivering web-based information to breast cancer patients. The implementation strategy was developed using the Replicating Effective Programs framework. Pilot testing measured the proportion that accepted the web-based information. A pre-consultation survey assessed whether the information was reviewed and the acceptability to stakeholders. Reasons for declining guided refinement to the implementation package. Eighty-two percent (309/377) accepted the web-based information. Of the 309 that accepted, 244 completed the pre-consultation survey. Participants were a median 59 years, white (98%), and highly educated (>50% with a college degree). Most patients who completed the questionnaire reported reviewing the website (85%), and nearly all found it helpful. Surgeons thought implementation increased visit efficiency (5/6) and would result in patients making more informed decisions (6/6). The most common reasons patients declined information were limited internet comfort or access (n = 36), emotional distress (n = 14), and preference to receive information directly from the surgeon (n = 7). Routine delivery of web-based information to breast cancer patients prior to the surgeon consultation is feasible. High stakeholder acceptability combined with the low implementation burden means that these findings have immediate relevance for improving care quality.

Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion

“… 259 +++ pediatric asthma clinic USA Asthma Patient education Demographic data, Patient awareness Patient-provider communication, Appointment intake information 15 19 Tucholka, J. L. et al [ 39 ] 2018 J Am Coll Surg Online and offline sources of information and support To assess the acceptability of a new strategy of pre-consultation prevention summaries and reminders in general practice. 377 patients +++ Breast cancer clinic USA Breast cancer Patient education Demographic data, Patient awareness Illness perceptions, Medication and treatment adherence 16 20 Aboumatar, H. J et al [ 66 ] 2013 J Gen Intern Med Online and offline sources of information and support Combining patient-oncologist intervention to improve communication in advanced cancer 41 primary care physicians and 275 of their patients +++ Primary care clinic USA Hypertension Patient education Demographic data, Patient awareness Appointment intake information 18 21 Albada, A. et al [ 29 ] 2015 Patient Educ Couns Electronic pre-office visit checklist To help reduce waiting times and duplication of work, improve patient pathways and decrease wasted visits 197 patients + Breast cancer clinic Norway Breast cancer Decision aid tools, Pre-assessment tools, Reminders Demographic data, Medical history, Family history, Reason for referral, Symptoms, Medication Patient-provider communication, Perceived involvement in care, Adherence to visit scheduling, Visit length 18 22 Bruce, J. et al [ 60 ] 2018 J Cancer Educ Online and offline sources of information and support To evaluate teen feedback on an asthma question intervention designed to motivate teens to be more engaged during visits and …”

“…The analysis showed that different types of pre-visit techniques have been employed by authors to facilitate office visits and patient care. All of these plans can be categorized into eight different categories, utilizing an electronic pre-office checklist with 12 studies (24.5%) [ 25 , 29 – 35 , 48 , 58 , 59 , 68 ], educating patients and support them before each visit in form of online and offline source of information with 12 studies (24.5%) [ 23 , 36 – 42 , 60 – 62 , 66 , 74 ], applying an EHR-linked care program with different checklists and assessment tools with nine studies (18.4%) [ 22 , 43 , 44 , 49 , 63 , 67 , 70 , 71 , 73 ], using paper-based checklists with nine studies (18.4%) [ 45 , 46 , 50 – 52 , 64 , 65 , 69 , 72 ], preparing and assess patient with the pre-visit phone-based intervention with two studies (4.1%) [ 24 , 53 ], using self-triage or self-assessment tools with two studies (4.1%) [ 54 , 55 ], using automatic reminders and sheets with one article (2%) [ 56 ], and using pre-clinic consultation by other health care team member with one article (2%) to prepare the patient for each visit [ 57 ].…”

“…According to findings, the most favorite types of pre-visit model were related to using electronic pre-office visit checklists and supporting patients by providing them with the necessary information in the form of online and offline training. In three articles, this information was provided to patients in the form of educational websites [ 37 , 39 , 40 , 60 ], while in the other six articles, the information was provided to patients in the form of training sessions before the patient’s visit and referring to the clinic [ 23 , 36 , 38 , 41 , 42 , 61 , 62 , 66 ].…”

A Randomized Controlled Trial Evaluating the Impact of Web-Based Information on Breast Cancer Patients' Knowledge of Surgical Treatment Options

“…Details of those patients declining study participation have been described in detail previously. 8 Of the 309 consented patients, 244 received the questionnaire and 227 completed at least three of the knowledge questions; most patients (94%) completed all five knowledge questions. These patients comprise our study cohort.…”

“…7 In our multi-disciplinary breast program, we successfully developed an implementation strategy that facilitates the routine delivery of a web-based decision aid directly to patients in the informational gap prior to the first surgical consultation. 8 Our pilot project demonstrated that this approach was feasible and highly acceptable to both patient and clinic stakeholders.…”