Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams

Haske van Veenendaal; Helene R. Voogdt-Pruis; Dirk T. Ubbink; Esther van Weele; Lejla Koco; Maaike Schuurman; Jannie Oskam; Ella Visserman; Carina G. J. M. Hilders

doi:10.1016/j.pec.2021.05.005

Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams

Haske van Veenendaal^*
, Helene R. Voogdt-Pruis
, Dirk T. Ubbink
, Esther van Weele
, Lejla Koco
, Maaike Schuurman
, Jannie Oskam
, Ella Visserman
, Carina G. J. M. Hilders

^*Corresponding author for this work

Erasmus University Rotterdam
Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
University Medical Center Utrecht
Amsterdam UMC - University of Amsterdam
Vestalia, Acaciapark 136, 1213 LD Hilversum, The Netherlands
Radboud University Medical Center
Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
Reinier de Graaf Groep

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the ‘Measurement Instrument for Determinants of Innovations-model’ (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.

Original language	English
Pages (from-to)	114-127
Number of pages	14
Journal	Patient education and counseling
Volume	105
Issue number	1
Early online date	2021
DOIs	https://doi.org/10.1016/j.pec.2021.05.005
Publication status	Published - Jan 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 17 Partnerships for the Goals

Keywords

Implementation
Implementation science, barriers and facilitators
Shared decision making
Timeout, breast cancer care

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Evaluation-of-a-multilevel-implementation-program-for-timeout-and-shared-decision-making-in-breast-cancer-care-a-mixed-.pdfFinal published version, 337 KBLicence: CC BY

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van Veenendaal, H., Voogdt-Pruis, H. R., Ubbink, D. T., van Weele, E., Koco, L., Schuurman, M., Oskam, J., Visserman, E., & Hilders, C. G. J. M. (2022). Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams. Patient education and counseling, 105(1), 114-127. https://doi.org/10.1016/j.pec.2021.05.005

@article{3c297f27fa3d4775bb1656f3dc400718,

title = "Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams",

abstract = "Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the {\textquoteleft}Measurement Instrument for Determinants of Innovations-model{\textquoteright} (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42\%). Clinicians (96\%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.",

keywords = "Implementation, Implementation science, barriers and facilitators, Shared decision making, Timeout, breast cancer care",

author = "\{van Veenendaal\}, Haske and Voogdt-Pruis, \{Helene R.\} and Ubbink, \{Dirk T.\} and \{van Weele\}, Esther and Lejla Koco and Maaike Schuurman and Jannie Oskam and Ella Visserman and Hilders, \{Carina G. J. M.\}",

note = "Funding Information: An unrestricted educational grant was provided by Zilveren Kruis Healthcare Insurance Company and the Dutch Ministry of Health , Grant Number is Z670 . Welfare and Sport. In-kind support was provided by the participating hospitals. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = jan,

doi = "10.1016/j.pec.2021.05.005",

language = "English",

volume = "105",

pages = "114--127",

journal = "Patient education and counseling",

issn = "0738-3991",

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}

van Veenendaal, H, Voogdt-Pruis, HR, Ubbink, DT, van Weele, E, Koco, L, Schuurman, M, Oskam, J, Visserman, E & Hilders, CGJM 2022, 'Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams', Patient education and counseling, vol. 105, no. 1, pp. 114-127. https://doi.org/10.1016/j.pec.2021.05.005

Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams. / van Veenendaal, Haske; Voogdt-Pruis, Helene R.; Ubbink, Dirk T. et al.
In: Patient education and counseling, Vol. 105, No. 1, 01.2022, p. 114-127.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams

AU - van Veenendaal, Haske

AU - Voogdt-Pruis, Helene R.

AU - Ubbink, Dirk T.

AU - van Weele, Esther

AU - Koco, Lejla

AU - Schuurman, Maaike

AU - Oskam, Jannie

AU - Visserman, Ella

AU - Hilders, Carina G. J. M.

N1 - Funding Information: An unrestricted educational grant was provided by Zilveren Kruis Healthcare Insurance Company and the Dutch Ministry of Health , Grant Number is Z670 . Welfare and Sport. In-kind support was provided by the participating hospitals. Publisher Copyright: © 2021 The Authors

PY - 2022/1

Y1 - 2022/1

N2 - Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the ‘Measurement Instrument for Determinants of Innovations-model’ (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.

AB - Objective: Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. Methods: The program was based on the ‘Measurement Instrument for Determinants of Innovations-model’ (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. Results: Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. Conclusion: Our program supported breast cancer clinicians to adopt SDM. Practice Implications: To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.

KW - Implementation

KW - Implementation science, barriers and facilitators

KW - Shared decision making

KW - Timeout, breast cancer care

UR - https://www.scopus.com/pages/publications/85106328091

U2 - 10.1016/j.pec.2021.05.005

DO - 10.1016/j.pec.2021.05.005

M3 - Article

C2 - 34016497

SN - 0738-3991

VL - 105

SP - 114

EP - 127

JO - Patient education and counseling

JF - Patient education and counseling

IS - 1

ER -

Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams

Abstract

UN SDGs

Keywords

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