Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach.

Simple Summary: This study examined the use of the Breast Cancer Surveillance Decision Aid (BCS-PtDA) in eight Dutch hospitals. This PtDA supports information provision (including information about personalized recurrence risks) and decision-making about post-treatment surveillance. Health care professionals (HCPs) acknowledged that the tool helped make patients aware of their options but felt it increased their workload without clear benefits. While the tool was effective in presenting choices to patients, deliberation about the options was scarce. The main challenges were related to the extra time required and HCPs' perception of the tool's value. Risk communication was deemed generally adequate. The study suggests that, while the PtDA offers benefits, better integration and communication strategies are needed to enhance shared decision-making processes. In conclusion, the implementation of the BCS-PtDA led to choices being offered to patients. However, there is room for improvement in information provision and the application of shared decision-making. Background: To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. Methods: Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. Results: The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. Discussion: When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved. [ABSTRACT FROM AUTHOR]