Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

摘要: BACKGROUND Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use conversation in routine care due to numerous barriers at clinical organizational levels. We explored factors that will promote the two early-stage breast cancer aids. examined differences opinions between across socioeconomic strata. METHODS nested this study within a randomized controlled trial demonstrated effectiveness surgery aids, one text-based picture-based. These facilitated more improved decision process, among other outcomes, four health systems with socioeconomically diverse patient populations. conducted semi-structured interviews purposive sample participants aid assignment status (SES) collected observations field notes. interviewed surgeons stakeholders. Two independent coders framework analysis using NOrmalization MeAsure Development through Normalization Process Theory. also an inductive analysis. additional sub-analyses based on SES. RESULTS 73 43 patients, 16 surgeons, 14 stakeholders like nurses, center directors, electronic record (EHR) experts. Patients felt should be used future were open various methods giving receiving (EHR, email, portal, before consultation). higher SES likely note influenced their treatment discussion, while patients lower noted influence decision-making. Intervention reported did not lengthen typical consultation time. Most intervention enhanced usual after it times, most appeared part normal routine. CONCLUSIONS Key guide implementation include adapting existing workflows, flexibility use, characteristics, communication preferences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03136367 , registered May 2, 2017.