Implementation of a Web-based Decision Aid for Breast Cancer Surgery

Overview

Routine incorporation of decision aids into oncology practice has the potential to significantly improve patients' experiences with cancer by increasing the likelihood that they make informed treatment decisions aligned with their values. Unfortunately, only a minority of the more than 1.6 million patients diagnosed annually with cancer ever receive one due to limited clinic resources for administration and challenges in timely identification of appropriate patients. Online delivery directly to patients addresses some of these barriers but is insufficient on its own to ensure accessibility for patients at the time they most benefit from support.19 It is critical that active, multi-faceted implementation strategies that target barriers to the widespread use of web-based decision aids be identified, as these tools have the potential to significantly improve the quality of oncologic care.

Based on strong preliminary work, the investigators have developed and piloted a package of implementation strategies that effectively overcomes barriers to delivery of a web-based breast cancer surgery decision aid in an academic and community clinic. Although the strategy was successful, patients were white and educated; further investigation is imperative in settings that provide care to underserved patients to ensure the intervention will mitigate, rather than worsen, existing disparities in breast cancer care. This is especially critical given that underserved patients may benefit most from shared decision-making interventions such as the one described. To study this, the investigators propose a pilot study within a clinic that serves a catchment area with a high proportion of African American, rural and low income patients. The investigators will iteratively assess and enhance our implementation package using concepts outlined in the Knowledge-to-Action Cycle, which emphasizes local context in balancing fidelity and flexibility. The specific aims are: 1) To identify patient and clinic level barriers to implementation of a web-based breast cancer surgery decision aid in a clinic that cares for underserved patients, and 2) To test and expand our current implementation package's ability to address barriers in a clinic that cares for underserved patients. The investigators will determine the reach of implementation and acceptability of this method of decision aid delivery to stakeholders.

Full Title of Study: “Implementation of a Web-based Decision Aid for Breast Cancer Surgery: Adapting to the Needs of Diverse Settings”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: March 31, 2020

Interventions

  • Other: Breast Cancer Surgery Decision Aid
    • We use a standard decision aid collaboratively developed by Health Dialog and the Informed Medical Decisions Foundation

Clinical Trial Outcome Measures

Primary Measures

  • Reach
    • Time Frame: measured over the 4 month implementation period
    • Reach of the implementation is defined as the proportion of patients over the four month implementation period who: 1) are sent the decision aid and 2) access the decision aid.

Secondary Measures

  • Acceptability
    • Time Frame: Survey sent within 4 weeks of surgical consultation
    • acceptability will be defined as >80% of patients reporting they would recommend receiving breast cancer information via email to others.
  • Barriers and Facilitators to Implementation of the Decision Aid
    • Time Frame: Interviewed completed within 6 months of the surgical consultation
    • One-on-one interviews with participants to identified experienced barriers and facilitaters to implementing the decision aid

Participating in This Clinical Trial

Patients:

Inclusion Criteria

  • Patients newly diagnosed with Stage 0-3 breast cancer.

Exclusion Criteria

  • None

Clinic Stakeholders:

Inclusion Criteria

clinical staff, clinic leadership, and surgeons involved in implementation Exclusion Criteria:

none

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 100 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Wisconsin, Madison
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Heather Neuman, Principal Investigator, University of Wisconsin, Madison
  • Overall Contact(s)
    • Cancer Connect, 800-622-8922, cancerconnect@uwcarbone.wisc.edu

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