Implementing a patient decision aid, a process evaluation of a large-scale pre- and post-implementation trial

Abstract

Purpose Patient decision aids (PtDAs) have been reported to have a positive influence on patients making a health care decision in trials. Nevertheless, post-trial implementation is poor. The aim of this study is to explore patient, clinician, and organizational success factors for implementing a PtDA designed for breast cancer patients, facing a decision on their radiation treatment. Methods We performed a process evaluation within a multi-center pre- and post-implementation trial. The PtDA was incorporated as much as possible in the logistics of 13 participating centers. Tracking data were collected on PtDA use. Process characteristics were recorded by both clinicians and patients. A logistic regression method was applied to investigate which process characteristics were significantly related to the probability that patients logged in to the PtDA. Results 189 patients received the PtDA of whom140 (77%) used the PtDA. If patients received the link via the surgery department they were more likely to use the PtDA (OR 9.77 (1.28–74.51)), compared to patients that received the link via the radiation oncology department. If the report of the multidisciplinary team stated that radiation treatment “had to be discussed with the patient”, patients were more likely to use the PtDA (OR 2.29 (1.12–4.71)). Educational level was not related to the probability of PtDA use. Conclusions We accomplished a high level of PtDA use. Patients were more likely to use the PtDA if they received the link via the surgery department and if “to be discussed with the patient” was written in the multidisciplinary team report.

A patient decision aid for breast cancer patients deciding on their radiation treatment, no change in decisional conflict but better informed choices

“…As described in a prior publication [26] , patients were recruited from 13 out of 19 radiation oncology centers in the Netherlands. Between October 2017 and October 2018, 214 patients were included in the control arm, of which 211 filled in the T1 questionnaire and 209 the T2 questionnaire.…”

“…Between October 2017 and October 2018, 214 patients were included in the control arm, of which 211 filled in the T1 questionnaire and 209 the T2 questionnaire. Between October 2018 and July 2019, 189 patients were included in the intervention arm, of which 185 filled in the T1 questionnaire, 140 patients used the PtDA [26] , and 180 filled in the T2 questionnaire ( Fig. 1 ).…”

“…Although we did not find a significant effect on the perceived level of SDM, the additional value of the PtDA was evaluated by patients as “good”. Of the patients who used the PtDA, 88% considered the PtDA to be useful for the decision-making process [26] . Therefore, more research is needed on how to improve integration of the PtDA in clinical practice while simultaneously improving the SDM process overall [56] , [57] .…”

“…We provided an e-learning opportunity, but this training was not obligatory. The logistics for referring patients to the PtDA were adjusted to the existing logistics and referral systems of the participating centers [26] . Ideally, patients were identified in the MDT.…”

“…The PtDA is available online in Dutch - with an additional English translation - at www.beslissamen.nl. We evaluated the PtDA in a multi-centre pre- and post-intervention study in 13 out of the 19 RT centers in the Netherlands [26] . The aim of this study is to investigate whether the PtDA resulted in improved decisional quality, an increased perceived level of SDM, and improved knowledge on the different treatment options.…”