Project Summary

PCORI funds implementation projects to increase awareness and promote the use of PCORI-funded research findings to improve healthcare practices and health outcomes. This project is proposing to conduct implementation activities for the results of the following research project: Helping Women with Breast Cancer Choose between Surgical Treatment Options.

1. What were the results of the original PCORI-funded study?

The original study compared the impact of Option Grid and Picture Option Grid conversation aids in combination with surgeon training on decision making for early-stage breast cancer treatment. We randomized surgeons to one of three arms: text-only Option Grid conversation aid, Picture Option Grid conversation aid, or usual care. Women in the Picture Option Grid arm (N = 248) had more knowledge about treatment options immediately after the surgical consultation and one-week postsurgery. They also had a better decision-making experience as measured immediately after the surgical consultation and at one-week postsurgery, lower decision regret at one-week postsurgery, and more shared decision making (SDM) compared with usual care. Women in the Option Grid arm had better decision-making experiences as measured immediately after the surgical consultation and at one-week postsurgery, better experience of care coordination at 12 weeks postsurgery, and more SDM during the encounter compared with usual care. The Picture Option Grid was more helpful for women who had lower health literacy levels and lower socioeconomic status.

2. Why is this research finding(s) important?

It is clear that patients value SDM; people wish to be informed, and they want their informed preferences to be considered carefully by clinicians. However, research has consistently shown that healthcare professionals, while generally accepting that an SDM approach is important, are not skilled at putting it into practice. Many well-known barriers exist. However, our research has shown that breast surgeons are very willing, when supported, to use conversation aids to help women with early-stage breast cancer become better informed. They are also happy to engage women in making the choice of breast surgery that best aligns with their preferences. It was important to the surgeons that the conversation aids were accurate, up to date, brief, well designed, and easy for patients to read. They also valued having a version with pictures, particularly for patients with lower health literacy. Research evidence supports the idea that well-designed conversation aids lead to much more SDM. Therefore, it is appropriate that these conversation aids are made available to women with early-stage breast cancer on a routine basis.

3. What is the goal of this project?

The overall goal of this project is to implement shared decision making across many breast care teams. To do this, the goal is to engage breast cancer teams in a learning collaborative in which clinicians from across the United States and beyond support one another in using conversation aids for early-stage breast cancer treatment decisions. We aim to (1) support clinical teams in adopting the Early-Stage Breast Cancer Surgery Option Grid conversation aids (one text-based Option Grid and one image-enriched Picture Option Grid); (2) evaluate the SDM strategy by examining which parts of the implementation strategy work best to increase use of the conversation aids; and (3) create a sustained learning collaborative in this clinical field to support breast care teams in using the conversation aids on an ongoing basis.

4. What is the project team doing?

At the core of our approach is the use of Option Grid conversation aids by women in conversation with trained healthcare professionals. Many other studies have confirmed the effectiveness of such aids. To support wider implementation, our approach will be embedded in a supported learning collaborative, the SDM Adoption and Implementation Resource (SHAIR) Collaborative. We will implement the conversation aids in breast surgery practices across the United States. To implement the conversation aids in as many settings as possible, we will use the diffusion of innovation theory to guide our design. The project team, advised by a senior group of experienced implementation and improvement scientists, is embedding the previous SDM strategy into a learning collaborative. Learning collaboratives are networks that focus on a set of goals, and are empowered to learn from one another, sharing data about progress on a regular basis. We will provide live and recorded webinars that will support the use/implementation of online and hard-copy access to the conversation aids. Because we understand to the importance of giving patients time to read these tools before their visits whenever possible, we will provide guidance and expert support for the collaborative members on how to integrate the conversation aids into their electronic healthcare records, telehealth, and patient portal systems.

5. How is the team evaluating this project?

We will evaluate the project by measuring the number of women given the opportunity to use one of the tools to support decision making. We will obtain data about the level of online access by tracking the paper copies given to women at the practice settings and by using online surveys administered to samples of women. The surveys will collect patient-reported outcomes of high relevance for this implementation project. In addition, we will assess which components of the SHAIR Collaborative are most successful at achieving the goals of this implementation project and how to achieve sustainability of the effort across settings, including finding long-term support for the collaborative itself.

6. How is the team involving patients and others in ensuring the findings reach people who can use them?

We have involved patients and a wide range of other stakeholders in this project. Specifically, we have four patient partners. All four participated in the WMM RCT, two of whom recruited women and collected trial data. We work with three patient advocacy organizations to guide the work. The American Society of Breast Surgeons is involved in developing the proposal, the SDM approach, and evaluation and sustainability plans.

7. How will this project help ensure future uptake and use of findings from patient-centered outcomes research?

The collaborative will develop and hone an implementation approach that will determine how conversation aids are best integrated into breast cancer surgery decision-making conversations. We are working with the American Society of Breast Surgeons (>3,000 members) and all our stakeholders to create a SHAIR Collaborative that will continue the work. As stated in its letter of support, the American Society of Breast Surgeons is willing to consider adopting the collaborative, should it prove to be effective.

Project Information

Glyn Elwyn, MD, PhD, MSc
Julie Margenthaler
Trustees of Dartmouth College

Key Dates

March 2021
June 2024

Initial PCORI-funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Helping Women with Breast Cancer Choose between Surgical Treatment Options


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The state where the project originates, or where the primary institution or organization is located.

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Last updated: November 23, 2021