Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making

Caldon, Lisa J M, Collins, Karen A, Reed, Malcolm W, Sivell, Stephanie, Austoker, Joan, Clements, Alison M, Patnick, Julietta and Elwyn, Glyn (2011) Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. Health Expectations, 14 (2). pp. 133-146. ISSN 1369-6513

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Abstract

Background: There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians.
Objective: To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. Methods As part of the development of a web-based DesI (BresDex), semi structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach.
Results: A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role.
Conclusions: The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice.

Item Type: Article
Keywords: Breast cancer, Breast conservation surgery, Breast conservation therapy, Decision aids, Decision support technology, Decision-making, Implementation science, Mastectomy, Patient decision support interventions, Patient involvement, Shared decision-making
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > R Medicine (General)
Depositing User: Esme Acton-Stewart
Date Deposited: 15 Apr 2016 13:30
Last Modified: 06 Apr 2017 15:33
URI: http://sro.sussex.ac.uk/id/eprint/56210

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