Background: Several treatments are available for patients with breast cancer (BC). Decision aids (DAs) are interventions that provide patients with information about available therapies, clarifying the congruence between decisions and personal values, and fostering shared decision-making (SDM), which is known to increase quality of care.
Aim: The aim is twofold: i) to investigate the diffusion of DAs in BC centers in Europe, including perceived barriers and facilitators; ii) to pilot the prototype of a web-based DA for BC patients, the Net Treatment Benefit application.
Methods: A cross-sectional, cross-country survey targeting breast specialists was distributed across BC networks. A scoping review was performed first, to inform the survey development. The questionnaire had 17 questions (4 Likert-scale, 4 multiple-choice, the remainder single-choice). Then, two focus groups (FGs) were conducted in the Academic Hospital of Udine (Italy) and the Champalimaud Foundation in Lisbon (Portugal) to test the usability, acceptability, feasibility and potential to support SDM of an application developed for BC patients facing the choice between endocrine-based therapy versus chemotherapy. The application runs statistical analyses of clinical-trial data using patient priorities among, efficacy, toxicity, and quality of life, using the Generalized Pairwise Comparisons statistical method.
Results: 198 valid responses were collected through the survey. Respondents were mostly medical oncologists (35%), or surgeons (35%). A good attitude towards a participatory communication approach (4.29 on a 1-5 scale, 95%CI: 4.15-4.44) was observed. Female respondents (62%) reported statistically significant higher scores than males, e.g., regarding the importance of involving caregivers in the decision-making, or the need to provide patients with DAs to foster engagement. Overall, 55% claimed that DAs were available in their organization, of which 86% reported to use them regularly. Paper-based DAs were the most common type in the sample. Developing DAs with scientific evidence was deemed the most important enabler for sustained uptake, while prevalence of uncodified communication strategies and poor integration in the hospital systems were considered the main barriers. FGs simulated different scenarios involving patient representatives and BC professionals, and lasted ~2 hours. The application prototype was assessed both qualitatively and through validated questionnaires. The latter reported high agreement levels (e.g., means >3.5 in Acceptability/Feasibility of Intervention Measure 1-5 scales). Patient representatives appreciated the use of evidence-based data when evaluating treatment regimens, whereas clinicians focused more on the implications from integrating the tool in daily practice. Overall, the application was well received by participants and holds promise in facilitating patient-clinician communication not only in BC, but also in other disease areas, provided that trial data are available.
Conclusions: This study suggests an insufficient availability of DAs in BC centers in Europe, mainly represented by paper-based tools rather than digital instruments, typically described in the literature. While future work needs to clarify the factors influencing the sustained implementation of DAs at the organizational level, this study sheds light on the current integration of DAs in BC care in Europe, explores developmental factors of a new web-based DA tool, and raises awareness on the importance of integrating SDM principles when communicating with patients.
Natalia Oprea is currently collaborating with Cergas (SDA Bocconi School of Management) on topics covering health governance and decision support and communication in health services. She has participated in several international research projects, including Horizon EU programme. Her research interests develop along two main tracks i) citizen involvement in the creation of value in public services and ii) the role of digital technologies for the public sector. Natalia earned her PhD in Comparative and European Politics at the University of Siena.
Vittoria Ardito is Junior Fellow of the Government, Health and Not for Profit Knowledge Group of SDA Bocconi School of Management, and a member of CeRGAS (Centre for Research on Health and Social Care Management). She is working on research projects both at the national and European levels (e.g., Horizon 2020). Her research activities develop mainly around the areas of health policy and Health Technology Assessment, with a recent focus on digital health (including mHealth and AI/ML), shared decision-making, and implementation science. Vittoria holds a BSc in Management and a MSc in International Management, both from Bocconi University.
Link zoom: https://unibocconi-it.zoom.us/j/99463393337?pwd=NWxUVG9ZNlQxMk84TG9VMVVvSk1IUT09
Meeting ID: 994 6339 3337
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