Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is using two conversation aids, shown to help women with early-stage breast cancer choose treatment, to support shared decision making in hospital and community clinics.

Patients with early-stage breast cancer can often choose between two treatment options. With a mastectomy, a surgeon removes the entire breast. With breast-conserving surgery, a surgeon removes only cancerous and nearby tissue. Patients usually need radiation after breast-conserving surgery. Although both treatments have benefits and risks, many women with early-stage breast cancer don’t take part in their treatment decision as much as they would like.

What is the goal of this implementation project?

In shared decision making, or SDM, patients and doctors work together to make health decisions. A PCORI-funded research study found that two conversation aids used during clinic visits helped women with early-stage breast cancer choose the treatment that works best for them. Both aids improved SDM, increased knowledge, and improved the decision process for women compared with usual care. Women found both aids easy to understand, and surgeons found them acceptable to use in their practice.

This project is using two conversation aids in clinics across North America to help patients with early-stage breast cancer make decisions about surgery.

What will this project do?

The project team is working with up to 33 clinics to make the conversation aids part of regular care. The first conversation aid is a one-page, easy-to-read table of surgery options. The second is a four-page, easy-to-read table of surgery options with pictures. This second aid was designed for people with limited health literacy. Health literacy is the ability to find, understand, and use information to make health decisions.

To support the use of the aids at the clinics, the project team is hosting an online learning collaborative called SHAIR, or Shared Decision Making Adaption and Implementation Resource. People who join a learning collaborative focus on a set of goals, share data about their progress, and learn from one another. The learning collaborative is including a lead clinician or other clinic staff member from each clinic.

The project team is supporting sites via the SHAIR website by offering:

  • Training on SDM and the conversation aids for clinicians
  • Support and guidance on using the aids with electronic health records, patient portals, and telehealth
  • Live and recorded webinars to support use of the aids
  • A dashboard to help clinics view data about their use of the aids

The project team is first introducing the aids and SHAIR to a small number of clinics. Based on lessons learned, they will refine the SHAIR website. Then the team is introducing the aids to the other sites.

What is the expected impact of this project?

The project is using the conversation aids at diverse clinics, including those at academic medical centers and community hospitals as well as community clinics. About 150 surgeons and 6,500 patients will use the conversation aids at the 33 sites. The project evaluation will confirm that the program is working as intended to help women make treatment decisions for early-stage breast cancer.

More about this implementation project:

Stakeholders Involved in This Project

  • American Society of Breast Surgeons
  • Susan G. Komen
  • American Cancer Society
  • Facing Our Risk of Cancer Empowered (FORCE)
  • BOLD Cancer Wellness Program (Bronx, NY)
  • The Breakfast Club, Inc. (St. Louis, MO)
  • Breast cancer survivors
  • EBSCO Health

Implementation Strategies

  • Promote shared decision making.
  • Adapt the shared decision making approach to work for sites’ existing resources and workflows, including integrating the conversation aid into the electronic health record.
  • Provide sites with IT and other tools to support implementation, including online dashboards for sites to view data on conversation aid referral and use, webinars on house to access and use the aids, and guidance on how to integrate them into electronic health record and patient portal systems, and telehealth processes.
  • Provide educational materials to patients, as part of decision aid.
  • Train breast surgeons on shared decision making, conversation aid integration into workflow and electronic health record systems, using virtual instructional webinars.
  • Use a phased implementation approach, launching the program with a small number of sites and then expanding to remaining sites.
  • Create a learning collaborative to support shared decision making and use of the conversation aids at sites.
  • Identify and prepare clinical champions at sites.
  • Provide technical assistance to sites, including practice facilitation, consultation, and help desk support.
  • Partner with national stakeholder organization to develop plans for further program scaleup.

Evaluation Outcomes

To document implementation:

  • Number and proportion of eligible women using the conversation aids
  • Use of implementation strategy components by learning collaborative members
  • Fidelity to the shared decision making process (audio-recorded visit encounters, patient surveys)
  • Assessing normalization at each site throughout project (surveys)

To assess healthcare and health outcomes:

  • Patient-reported shared decision making and decisional conflict (collaboRATE, SURE)
  • Patient knowledge of treatment options
  • Care coordination (integRATE)
  • Treatment choice

Project Information

Glyn Elwyn, MD, PhD, MSc
Julie Margenthaler
Trustees of Dartmouth College
Implementing Shared Decision Making for Breast Cancer Using a Coproduction Learning Collaborative

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

Related Dissemination and Implementation Project

Using a Decision Aid to Help Patients Make Decisions about Fibroid Treatment


State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Project Details Type
Last updated: March 15, 2024