Development and pilot testing of a decision aid for navigating breast cancer survivorship care

BMC Medical Informatics and Decision Making

Research

Ivy Cheng¹  Alexandre Chan²  Yu Ke³  Gretchen Ser Hua Tan³  Rose Wai Yee Fok⁴  Jack Junjie Chan⁴  Kiley Wei-Jen Loh⁵ 

[1] Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore;Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore;Duke-NUS Medical School Singapore, Singapore, Singapore;Department of Clinical Pharmacy Practice, University of California Irvine, 515 Bison Modular 147B, 92697, Irvine, CA, USA;Department of Pharmacy, National University of Singapore, Singapore, Singapore;Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore;Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore;

关键词: Cancer;    Alpha testing;    Development;    Survivorship;    Decision aid;    Shared decision making;    Care models;   

DOI  :  10.1186/s12911-022-02056-5

 received in 2022-07-04, accepted in 2022-11-17,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe predominant oncologist-led model in many countries is unsustainable to meet the needs of a growing cohort of breast cancer survivors (BCS). Despite available alternative models, adoption rates have been poor. To help BCS navigate survivorship care, we aimed to systematically develop a decision aid (DA) to guide their choice of follow-up care model and evaluate its acceptability and usability among BCS and health care providers (HCPs).MethodsWe recruited BCS aged ≥ 21 years who have completed primary treatment and understand English. BCS receiving palliative care or with cognitive impairment were excluded. HCPs who routinely discussed post-treatment care with BCS were purposively sampled based on disciplines. Each participant reviewed the DA during a semi-structured interview using the ‘think aloud’ approach and completed an acceptability questionnaire. Descriptive statistics and directed content analysis were used.ResultsWe conducted three rounds of alpha testing with 15 BCS and 8 HCPs. All BCS found the final DA prototype easy to navigate with sufficient interactivity. The information imbalance favouring the shared care option perceived by 60% of BCS in early rounds was rectified. The length of DA was optimized to be ‘just right’. Key revisions made included (1) presenting care options side-by-side to improve perceived information balance, (2) creating dedicated sections explaining HCPs’ care roles to address gaps in health system contextual knowledge, and (3) employing a multicriteria decision analysis method for preference clarification exercise to reflect the user’s openness towards shared care. Most BCS (73%) found the DA useful for decision-making, and 93% were willing to discuss the DA with their HCPs. Most HCPs (88%) agreed that the DA was a reliable tool and would be easily integrated into routine care.ConclusionsOur experience highlighted the need to provide contextual information on the health care system for decisions related to care delivery. Developers should address potential variability within the care model and clarify inherent biases, such as low confidence levels in primary care. Future work could expand on the developed DA’s informational structure to apply to other care models and leverage artificial intelligence to optimize information delivery.

【 授权许可】

CC BY   
© The Author(s) 2022

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