TY - JOUR
T1 - Use of web-based decision support to improve informed choice for chemoprevention
T2 - a qualitative analysis of pre-implementation interviews (SWOG S1904)
AU - Michel, Alissa M.
AU - Yi, Haeseung
AU - Amenta, Jacquelyn
AU - Collins, Nicole
AU - Vaynrub, Anna
AU - Umakanth, Subiksha
AU - Anderson, Garnet
AU - Arnold, Katie
AU - Law, Cynthia
AU - Pruthi, Sandhya
AU - Sandoval-Leon, Ana
AU - Shirley, Rachel
AU - Perdekamp, Maria Grosse
AU - Colonna, Sarah
AU - Krisher, Stacy
AU - King, Tari
AU - Yee, Lisa D.
AU - Ballinger, Tarah J.
AU - Braun-Inglis, Christa
AU - Mangino, Debra A.
AU - Wisinski, Kari
AU - DeYoung, Claudia A.
AU - Ross, Masey
AU - Floyd, Justin
AU - Kaster, Andrea
AU - VanderWalde, Lindi
AU - Saphner, Thomas J.
AU - Zarwan, Corrine
AU - Lo, Shelly
AU - Graham, Cathy
AU - Conlin, Alison
AU - Yost, Kathleen
AU - Agnese, Doreen
AU - Jernigan, Cheryl
AU - Hershman, Dawn L.
AU - Neuhouser, Marian L.
AU - Arun, Banu
AU - Crew, Katherine D.
AU - Kukafka, Rita
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - Background: Women with high-risk breast lesions, such as atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS), have a 4- to tenfold increased risk of breast cancer compared to women with non-proliferative breast disease. Despite high-quality data supporting chemoprevention, uptake remains low. Interventions are needed to break down barriers. Methods: The parent trial, MiCHOICE, is a cluster randomized controlled trial evaluating the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. For this pre-implementation analysis, 25 providers participated in semi-structured interviews prior to accessing decision support tools. Interviews sought to understand attitudes/beliefs and barriers/facilitators to chemoprevention. Results: Interviews with 25 providers (18 physicians and 7 advanced practice providers) were included. Providers were predominantly female (84%), white (72%), and non-Hispanic (88%). Nearly all providers (96%) had prescribed chemoprevention for eligible patients. Three themes emerged in qualitative analysis. The first theme describes providers’ confidence in chemoprevention and the utility of decision support tools. The second theme elucidates barriers to chemoprevention, including time constraints, risk communication and perceptions of patients’ fear of side effects and anxiety. The third theme is the need for early implementation of decision support tools. Conclusions: This qualitative study suggests that providers were interested in the early inclusion of decision aids (DA) in their chemoprevention discussion workflow. The DAs may help overcome certain barriers which were elucidated in these interviews, including patient level concerns about side effects, clinic time constraints and difficulty communicating risk. A multi-faceted intervention with a DA as one active component may be needed. Trial registration: This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT04496739.
AB - Background: Women with high-risk breast lesions, such as atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS), have a 4- to tenfold increased risk of breast cancer compared to women with non-proliferative breast disease. Despite high-quality data supporting chemoprevention, uptake remains low. Interventions are needed to break down barriers. Methods: The parent trial, MiCHOICE, is a cluster randomized controlled trial evaluating the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. For this pre-implementation analysis, 25 providers participated in semi-structured interviews prior to accessing decision support tools. Interviews sought to understand attitudes/beliefs and barriers/facilitators to chemoprevention. Results: Interviews with 25 providers (18 physicians and 7 advanced practice providers) were included. Providers were predominantly female (84%), white (72%), and non-Hispanic (88%). Nearly all providers (96%) had prescribed chemoprevention for eligible patients. Three themes emerged in qualitative analysis. The first theme describes providers’ confidence in chemoprevention and the utility of decision support tools. The second theme elucidates barriers to chemoprevention, including time constraints, risk communication and perceptions of patients’ fear of side effects and anxiety. The third theme is the need for early implementation of decision support tools. Conclusions: This qualitative study suggests that providers were interested in the early inclusion of decision aids (DA) in their chemoprevention discussion workflow. The DAs may help overcome certain barriers which were elucidated in these interviews, including patient level concerns about side effects, clinic time constraints and difficulty communicating risk. A multi-faceted intervention with a DA as one active component may be needed. Trial registration: This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT04496739.
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U2 - 10.1186/s12911-024-02691-0
DO - 10.1186/s12911-024-02691-0
M3 - Article
C2 - 39334347
AN - SCOPUS:85205336063
SN - 1472-6947
VL - 24
JO - BMC Medical Informatics and Decision Making
JF - BMC Medical Informatics and Decision Making
IS - 1
M1 - 272
ER -