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

Abstract

PURPOSE: Implementing shared decision making (SDM), recommended in screening mammography by national guidelines for women age 40-49 years, faces challenges that innovations in quality improvement and team science (TS) are poised to address. We aimed to improve the effectiveness, patient-centeredness, and efficiency of SDM in primary care for breast cancer screening. METHODS: Our interdisciplinary team included primary and specialty care, psychology, epidemiology, communication science, engineering, and stakeholders (patients and clinicians). Over a 6-year period, we executed two iterative cycles of plan-do-study-act (PDSA) to develop, revise, and implement a SDM tool using TS principles. Patient and physician surveys and retrospective analysis of tool performance informed our first PDSA cycle. Patient and physician surveys, toolkit use, and clinical outcomes in the second PDSA cycle supported SDM implementation. We gathered team member assessments on the importance of individual TS activities. RESULTS: Our first PDSA cycle successfully generated a SDM tool called Breast Cancer Risk Estimator, deemed valuable by 87% of patients surveyed. Our second PDSA cycle increased Breast Cancer Risk Estimator utilization, from 2,000 sessions in 2017 to 4,097 sessions in 2019 while maintaining early-stage breast cancer diagnoses. Although TS activities such as culture, trust, and communication needed to be sustained throughout the project, shared goals, research/data infrastructure support, and leadership were more important earlier in the project and persisted in the later stages of the project. CONCLUSION: Combining rigorous quality improvement and TS principles can support the complex, interdependent, and interdisciplinary activities necessary to improve cancer care delivery exemplified by our implementation of a breast cancer screening SDM tool.

Teams, Teaming, and Complex Systems in Cancer Care

“…This requires mechanisms to both incorporate different perspectives and integrate their implications. Such mechanisms include prebriefs and cross-checking in direct patient care, 16 decision support systems for diagnoses (Burnside), 17 the creation of pediatric-onco dental teams to address oral infection (Bledsaw), 18 and collaborative multidisciplinary smoking cessation treatment programs (Cooper). 19 Are Various Roles and Responsibilities Clear?…”

Technology Supports to Cancer Care Teams: Promises and Pitfalls

“…In a single-site project using two Plan-Do-Study-Act cycles, women and their primary care physicians reported improved shared decision making after use of the adapted B~Care 2.0, a web-based tool to share key facts about screening mammography and depict personalized risk/benefit assessments. 1 A key strength of the adapted tool was full integration into the health system's electronic health record. Iterative use of Plan-Do-Study-Act cycles resulted in high adoption and end-user satisfaction.…”