Healthcare professionals’ behaviour regarding the implementation of shared decision-making in screening programmes: A systematic review

Hernández-Leal, María José; Pérez-Lacasta, María José; Feijoo-Cid, María; Ramos‐García, Vanesa; Carles-Lavila, Misericòrdia

doi:10.1016/j.pec.2021.01.032

Cited by 11 publications

(13 citation statements)

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“…We included shared decision-making in our discussion group guide as an innovative strategy in screening. We were interested in knowing the views of health professionals about their implementation, considering that some barriers that have been reported in the literature have their origin in professionals' resistance to change [58].…”

Section: Plos Onementioning

confidence: 99%

Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study

et al. 2022

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Background With the aim of increasing benefits and decreasing harms, risk-based breast cancer screening has been proposed as an alternative to age-based screening. This study explores barriers and facilitators to implementing a risk-based breast cancer screening program from the perspective of health professionals, in the context of a National Health Service. Methods Socio-constructivist qualitative research carried out in Catalonia (Spain), in the year 2019. Four discussion groups were conducted, with a total of 29 health professionals from primary care, breast cancer screening programs, hospital breast units, epidemiology units, and clinical specialties. A descriptive-interpretive thematic analysis was performed. Results Identified barriers included resistance to reducing the number of screening exams for low-risk women; resistance to change for health professionals; difficulties in risk communication; lack of conclusive evidence of the benefits of risk-based screening; limited economic resources; and organizational transformation. Facilitators include benefits of risk-based strategies for high and low-risk women; women’s active role in their health care; proximity of women and primary care professionals; experience of health professionals in other screening programs; and greater efficiency of a risk-based screening program. Organizational and administrative changes in the health system, commitment by policy makers, training of health professionals, and educational interventions addressed to the general population will be required. Conclusions Despite the expressed difficulties, participants supported the implementation of risk-based screening. They highlighted its benefits, especially for women at high risk of breast cancer and those under 50 years of age, and assumed a greater efficiency of the risk-based program compared to the aged-based one. Future studies should assess the efficiency and feasibility of risk-based breast cancer screening for its transfer to clinical practice.

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Section: Plos Onementioning

confidence: 99%

Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study

et al. 2022

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“…To counteract this, we count on the expected positive results of the clinical trials now underway, the development of guidelines for facilitating implementation [6,22], experience with the current screening program, the perception of professionals that risk-based screening is beneficial for women and raising awareness in society of the advantages of a risk-based approach through the mass media [23]. Other facilitators include training in communication skills, empathy, active listening, and non-verbal language [24]; integrating dynamic risk assessment tools into each individual's medical records to determine risk, update screening recommendations, and communicating these updates to participants and their healthcare providers [25]; and developing country-specific standardized protocols for the assessment and communication of risk, and provision of screening and prevention recommendations [15].…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals

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Hernández-Leal

Carles-Lavila

et al. 2022

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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 the 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. The 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, the 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.

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“…While 83% of health professionals were strongly interested in promoting SDM during the clinical encounter,28 they admitted that their lack of training in the SDM model was one of the most significant barriers to its implementation in the screening context 13…”

Section: Discussionmentioning

confidence: 99%

“…How to improve the application of SDM to screening While 83% of health professionals were strongly interested in promoting SDM during the clinical encounter, 28 they admitted that their lack of training in the SDM model was one of the most significant barriers to its implementation in the screening context. 13 A review of the training health professionals had received confirmed our belief that there is a lack of strategies to familiarise health professionals with this model. In Spain, the topic has been introduced into medicine and health-related degree programmes.…”

Section: Open Accessmentioning

confidence: 94%

“…In 2017, Toledo-Chavari and their colleagues created PtDAs 5 (online supplemental file 1), consisting of a trifold leaflet that provided balanced information on either the benefits or adverse effects, for both professionals and women, to be used during the clinical appointment. However, based on the barriers and enabling factors cited in the literature, [11][12][13] the researchers decided not to use the PtDAs alone, for it was not enough, and concluded that SDM training material aimed at health professionals was also needed. The manual is training material, since it is a useful tool to transmit knowledge and provide quick and simple information on how to operationalise new practices, introducing beginners into the theme on how to use it the same way advanced users do.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Development of support material for health professionals who are implementing Shared Decision-making in breast cancer screening: validation using the Delphi technique

et al. 2022

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BackgroundThe Literature is no report support material on Shared Decision-making applied to breast cancer screening that is intended for Spanish health professionals. The researcher created both a handbook and a guide for this topic using an adaption of the Three-talk model.ObjectiveA Delphi method will be used to reach an agreement among experts on the contents and design of a manual and guide, designed by the research team, and to be used by health professionals in the application of SDM in breast cancer screening.DesignA qualitative study. The content and design of the handbook and the guide was discussed by 20 experts. The Delphi techniques was in an online mode between July and October 2020 and researchers used Google forms in three rounds with open and closed questions. The criterion established for consensus was a coefficient of concordance (Cc) above 75, for questions using a Likert scale of 1–6—in which 1 meant ‘completely disagree’ and 6 ‘completely agree’—with a cut-off point equal to or higher than 4.ResultsParticipants considered the Three-talk model suitable for the screening context. The handbook sections and level of detail were considered satisfactory (Cc=90). The summary provided by the clinical practice guide was considered necessary (Cc=75), as it was the self-assessment tool for professionals (Cc=85). Content was added: addressing the limitations of the SDM model; extending the number of sample dialogues for health professionals; providing supplementary resources on using Patient Decisions aids and adding references on communication skills.Conclusions and applicationsThe first handbook and clinical practice guide providing unique SDM support material for health professionals have been developed. The handbook and guide are useful and innovative as supporting material for health professionals, but training strategies for SDM and a piloting plan for the use of materials are requested, in order to facilitate its implementation.

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Healthcare professionals’ behaviour regarding the implementation of shared decision-making in screening programmes: A systematic review

Cited by 11 publications

References 53 publications

Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study

Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study

Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals

Development of support material for health professionals who are implementing Shared Decision-making in breast cancer screening: validation using the Delphi technique

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