Abstract
Implementing shared decision making (SDM), recommended in screening mammography by national guidelines for women age 40-49 years, faces challenges that innovations in quality improvement and team science (TS) are poised to address. We aimed to improve the effectiveness, patient-centeredness, and efficiency of SDM in primary care for breast cancer screening.
Our interdisciplinary team included primary and specialty care, psychology, epidemiology, communication science, engineering, and stakeholders (patients and clinicians). Over a 6-year period, we executed two iterative cycles of plan-do-study-act (PDSA) to develop, revise, and implement a SDM tool using TS principles. Patient and physician surveys and retrospective analysis of tool performance informed our first PDSA cycle. Patient and physician surveys, toolkit use, and clinical outcomes in the second PDSA cycle supported SDM implementation. We gathered team member assessments on the importance of individual TS activities.
Our first PDSA cycle successfully generated a SDM tool called Breast Cancer Risk Estimator, deemed valuable by 87% of patients surveyed. Our second PDSA cycle increased Breast Cancer Risk Estimator utilization, from 2,000 sessions in 2017 to 4,097 sessions in 2019 while maintaining early-stage breast cancer diagnoses. Although TS activities such as culture, trust, and communication needed to be sustained throughout the project, shared goals, research/data infrastructure support, and leadership were more important earlier in the project and persisted in the later stages of the project.
Combining rigorous quality improvement and TS principles can support the complex, interdependent, and interdisciplinary activities necessary to improve cancer care delivery exemplified by our implementation of a breast cancer screening SDM tool.
© 2022 by American Society of Clinical OncologyConception and design: Elizabeth S. Burnside, Sarina Schrager, Lori DuBenske, Amy Trentham-Dietz, Dhavan Shah, Oguzhan Alagoz
Administrative support: Elizabeth S. Burnside, Terry Little
Provision of study materials or patients: Sarina Schrager, Amy Trentham-Dietz
Collection and assembly of data: Elizabeth S. Burnside, Sarina Schrager, Lori DuBenske, Jon Keevil, Terry Little, Amy Trentham-Dietz, Dhavan Shah, Oguzhan Alagoz
Data analysis and interpretation: Elizabeth S. Burnside, Sarina Schrager, Jon Keevil, Amy Trentham-Dietz, Betsy Rolland, Dhavan Shah, Oguzhan Alagoz
Manuscript writing: All authors
Final approval of manuscript: All authors
Accountable for all aspects of the work: All authors
AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
Team Science Principles Enhance Cancer Care Delivery Quality Improvement: Interdisciplinary Implementation of Breast Cancer Screening Shared Decision Making
The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.
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Oguzhan Alagoz
Consulting or Advisory Role: Bristol Myers Squibb, Exact Sciences, Johnson & Johnson/Janssen
No other potential conflicts of interest were reported.
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