Primary Care–Based Staff Ideas for Implementing a Mammography Decision Aid for Women 75+: a Qualitative Study

Abstract

BACKGROUND: We previously developed a pamphlet decision aid (DA) on mammography screening for women ≥ 75 years. However, implementing DAs in primary care may be challenging and may require support from nonphysician healthcare team members. OBJECTIVE: To learn from primary care administrators, nurses, and staff their thoughts on how best to implement a mammography DA for women ≥ 75 years in practice. DESIGN: Qualitative study entailing in-person individual interviews using a semi-structured interview guide. PARTICIPANTS: Thirty-two non-physician healthcare team members (69.6% of those approached) participated from 8 different primary care practices (community and academic) in the Boston area or in Chapel Hill, NC. APPROACH: Participants were asked to provide feedback on the DA, their thoughts on ways to make the DA available to older women, and factors that would make it easier and/or harder to implement. KEY RESULTS: Participants felt the DA was clear, balanced, and understandable, but felt that it needed to be shorter for women with low health literacy. Most participants felt that as long as use of the DA was approved and supported by clinicians that women ≥ 75 years should receive the DA before a visit from staff (usually medical assistants) so that patients could ask their clinicians questions during the visit. Facilitators of DA use included its perceived helpfulness with decision-making, its format, and that existing systems (panel management, electronic medical record alerts) could be accessed to get the DA to patients especially at Medicare Annual Wellness visits. Participants perceived a need for training, albeit minimal, to provide the DA to patients. Barriers of DA use included competing demands on clinician and staff time. CONCLUSIONS: Participants felt that as long as use of the mammography DA for women ≥ 75 years was supported by clinicians, it would be feasible to implement with minimal refinements to existing healthcare system processes.

Primary care provider perspectives on screening mammography in older women: A qualitative study

“…These disparate levels of patient empowerment may contribute to the differences that have been observed in rates of screening mammography utilization based on race and insurance status ( Martires et al, 2014 , Rikard et al, 2016 ). Our findings indicate that the implementation of decision tools, such as those developed by Schonberg et al, 2019 , Schonberg et al, 2020 , Talking to Patients about Breast Cancer Screening, 2020 in clinical practice could be vital in ensuring all patients are able to make informed decisions about their care and thus empower them to participate in the shared decision-making process ( Kadivar et al, 2014 ).…”

Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

“…Clinical barriers faced by clinicians can include a lack of training on the conversation aids, indifference to using them, lack of trust in the content, and possible disruption of established clinic behaviors and workflows [5]. While training is recognized by clinic staff as an important way to promote shared decision-making and the use of conversation aids, a common barrier to implementation is the lack of appropriate training on how best to use and integrate the conversation aids [4,5,14].…”

“…In breast cancer care, clinicians tend to feel they communicate well with their patients and are reluctant to modify aspects of their usual care [15]. Clinicians also worry that it takes too much time to use a conversation aid and engage in shared decision-making [14,16]. Buyin at the clinic level, led by clinical champions, can reinforce the sustainability of an implemented conversation aid [17].…”

Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

“…[5] While training is recognized by clinic staff as an important way to promote shared decision making and the use of conversation aids, a common barrier to implementation is the lack of appropriate training on how best to use and integrate the conversation aids. [4,5,14] In breast cancer care, clinicians tend to feel they communicate well with their patients and are reluctant to modify aspects of their usual care. [15] Clinicians also worry that it takes too much time to use a conversation aid and engage in shared decision making.…”

“…[15] Clinicians also worry that it takes too much time to use a conversation aid and engage in shared decision making. [14,16] Buy-in at the clinic level, led by clinical champions, can reinforce the sustainability of an implemented conversation aid. [17] Despite the multiple barriers that exist, tailoring to the individual needs of clinics can ensure better sustainability of an implemented conversation aid.…”