Abstract
IntroductionShared decision-making (SDM) in breast cancer care lacks routine implementation. We initiated the SHared decision-making Adoption and Implementation Resource (SHAIR) online coproduction learning collaborative to promote early-stage breast cancer surgery SDM by implementing effective text and picture-enhanced conversation aids in preoperative care after brief training.1 2MethodsWe are conducting a phased implementation: phase 1 pilot at five sites and phase 2 scale-up across additional North American sites. We are using RE-AIM for evaluation3 and a feedback dashboard for displaying primary and some secondary outcomes to SHAIR sites. Our primary outcome is patient reach. Secondary outcomes include patient-reported SDM (collaboRATE), decisional conflict (SURE), healthcare delivery integration (integRATE), treatment choice, intervention normalization (Normalization MeAsure Development questionnaire4), intervention adaptation (Framework for Reporting Adaptations and Modifications-Extended/-Implementation Strategies5), implementation strategies, and sustainability (working with the American Society of Breast Surgeons).ResultsAcross 15 sites, SHAIR has reached 1,553 patients, reaching 85% of all eligible patients. Patient surveys (n=279) report: (1) CollaboRATE with 72.5% top score (n=169/233); (2) integRATE with 10.46/12 (n=230/279); (3) SURE (decisional conflict) with 87.45% top score (n=202/231); and (4) treatment choice preferences, with over half reporting choosing lumpectomy with radiation. The American Society of Breast Surgeons will offer access to the conversion aids and SHAIR-developed brief SDM training on its forum and website. Final SHAIR results, including NoMAD and FRAME results, in June 2024.DiscussionSHAIR has reached a significant proportion of the eligible patient population at participating sites and patients are reporting high SDM.Conclusion(s)Providing access to CAs, brief training, and feedback dashboard within a learning collaborative has led to significant patient reach. We will report final results in June 2024.This research was funded through a Patient-Centered Outcomes Research Institute Award (SDM-2020C2–20307). This work is solely the responsibility of the authors and does not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.ReferencesSchubbe D, Yen RW, Leavitt H, et al. Implementing shared decision making for early-stage breast cancer treatment using a coproduction learning collaborative: the SHAIR Collaborative protocol. Implement Sci Commun. 2023;4(1):79. doi:10.1186/s43058-023-00453-z.Durand MA, Yen RW, O’Malley AJ, et al. What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata. Cancer. Published online November 10, 2020. doi:10.1002/cncr.33248.Gaglio B, Shoup JA, Glasgow RE. The RE-AIM Framework: A Systematic Review of Use Over Time. Am JPublic Health. 2013;103(6):e38-e46. doi:10.2105/AJPH.2013.301299.Lamarche L, Clark RE, Parascandalo F, Mangin D. The implementation and validation of the NoMAD during a complex primary care intervention. BMC Med Res Methodol. 2022;22(1):175.doi:10.1186/s12874-022-01655-0.Miller CJ, Barnett ML, Baumann AA, Gutner CA, Wiltsey-Stirman S. The Frame-is: a framework for documenting modifications to implementation strategies in healthcare. Implement Sci. 2021;16(1):36. doi:10.1186/s13012-021-01105-3.