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42 ONCOLOGISTS' AND NURSES' VIEWS ON THE IMPLEMENTATION OF DECISION AIDS ON SECOND-LINE PALLIATIVE CHEMOTHERAPY IN ROUTINE PRACTICE

Friday, October 19, 2012
The Atrium (Hyatt Regency)
Poster Board # 42
Decision Psychology and Shared Decision Making (DEC)
Candidate for the Lee B. Lusted Student Prize Competition

Linda J.M. Oostendorp, MSc1, Petronella B. Ottevanger, MD, PhD1, Winette T.A. Van der Graaf, Prof, MD1, Rosella P.M.G. Hermens, PhD1 and Peep F.M. Stalmeier, PhD2, (1)Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, (2)Radboud UMC, Nijmegen, Netherlands

Purpose: Few decision aids for treatment decisions in the advanced cancer setting are implemented in routine practice. We have developed decision aids on second-line palliative chemotherapy for advanced breast or colorectal cancer, which are offered to patients by a nurse. This study explores views of medical oncologists and nurses on barriers and facilitators to use these decision aids in routine practice.

Method: Data were collected through semi-structured interviews with 14 medical oncologists and 12 nurses in the Netherlands. Most of the interviewees had previously participated in a trial evaluating the decision aids. Interviews were audio taped, fully transcribed and then analyzed based on three theoretical models of implementation of innovations in clinical practice. These models included factors related to the decision aid itself, the professionals, the patient, and the organization.

Result: Most participants acknowledged the relevance of shared decision-making and decision aids. The most important barriers were the opinions and attitudes of oncologists and nurses, and included that the information from the decision aid could have a negative impact on patients, that the information should be customized to the individual patient, that oncologists wish to stay involved in the decision, and that doubts existed about the added value of the aids. Other important barriers were related to the current organization of patient care; for example, the decision about second-line chemotherapy is often made before the patient is seen by the nurse presenting the decision aid. Factors enhancing implementation of the decision aids are: more user-friendly decision aids, education about the positive effects of the decision aids, and integration of the decision aids in the care pathway.

Conclusion: This study showed that the first step to a successful implementation of these decision aids is to bring about a change in the opinions and attitudes of the professionals. Based on the identified barriers and facilitators, a tailored implementation strategy will be developed.

See more of: POSTER SESSION 3

See more of: The 34th Annual Meeting of the Society for Medical Decision Making