Preliminary Evaluation of a Breast Cancer Screening Shared Decision-Making Aid Utilized Within the Primary Care Clinical Encounter

Abstract

Introduction: The US Preventative Services Task Force recommends shared decision-making (SDM) between women aged 40 and 49 years and their physician regarding timing of mammography screening. This preliminary study evaluates women’s and physician’s satisfaction using Breast Cancer Risk Estimator & Decision Aid (BCARE-DA), a shared decision aid utilized during the clinical encounter, and examines SDM quality for these encounters. Methods: Fifty-three women and their physician utilized BCARE-DA and completed surveys measuring satisfaction with Likert-type and open-ended items and women completed the Decision Conflict Scale. Clinic visit transcripts were evaluated for SDM quality using Observer OPTION-5 and Breast Cancer Screening Decision Core Components Checklist. Results: Women and physicians positively evaluated BCARE-DA. Women had low decision conflict. Physicians demonstrated moderate effort toward SDM, greatest in offering options, and lowest for team talk. Physicians demonstrated 2/3 of core SDM elements in 80% to 100% of encounters. Conclusion: Preliminary findings suggest specific promise for such Decision Aids to facilitate SDM through understanding of personal risks for breast cancer formulated within each screening option, while some SDM elements likely require additional facilitating.

Team Science Principles Enhance Cancer Care Delivery Quality Improvement: Interdisciplinary Implementation of Breast Cancer Screening Shared Decision Making

“…Provider-identified barriers included not enough time for discussion although having the SDM available in the EHR helped. 28,30,31 We also found that primary care provider framing of risk and potential outcomes during the SDM interaction influenced patient satisfaction. 31…”

“…After these providers engaged in conversations with 51 women considering mammography using B~CARE 1.0, we surveyed these patients and providers to assess feasibility, satisfaction, and potential outcomes [29][30][31] (Study). On the basis of patient 30,32 and provider 30 PDSA cycle 2 (January 1, 2016-December 31, 2018): Our team codified core components of breast cancer screening SDM via a Delphi 33 -see the Data Supplement for details of patient/provider contributions, the development of a Toolkit, 34 and alignment with UW Health clinical SDM guidelines in preparation for widespread clinical use of B~CARE 2.0 (Plan). During the B~CARE 2.0 rollout, we aligned organizational leadership to support a dedicated educational campaign for all primary care providers (Do).…”

Patient-provider communication while using a clinical decision support tool: explaining satisfaction with shared decision making for mammography screening

“…This study examined these issues in the context of a CDST called the Breast Cancer Risk Estimator-Decision Aid (BCaRE-DA), a software platform designed for collaborative use by patients and providers to support informed breast cancer screening decisions, and emphasizing average risk women aged 40–49, for whom these decisions can be particularly challenging [ 23 , 40 ]. BCaRE-DA seeks to help the patient-provider dyad engage in a thorough, systematic, and interactive process in which they touch on factors including women’s family history, race, ethnicity, and breast density, and enter these data into the tool to allow personalization of an individual’s risk profile.…”

Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis

“…The selected studies reported on a broad variety of conditions: oncology [33,35,45,47,49,[64][65][66]69,86,90,91], musculoskeletal disorders [34,40,42,44,48,50,55,81,84,87], cardiovascular disease [36,[51][52][53]70,78,93,94], general practice consultations [68,71,73,75,80,83,95], mental disorders [32,39,41,60,61,82], diabetes mellitus type II [37,43,46], elective otolaryngologic surgery [72,88,92], asthma [57,…”

“…These showed conflicting evidence as to the effect of these SDM-interventions on consultation duration: From the seven highquality RCTs included [33,42,48,52,55,57,95], three showed a significant increase in consultation duration [42,48,52], while four showed no significant change (Table 1) [43,55,57,95]. Of the 28 included lower-quality studies, four showed significant increases [38,63,86,100], one a significant decrease [33], and 23 showed no significant change in consultation duration in the intervention group compared to control.…”