Implementing breast cancer decision aids in community sites: barriers and resources

OBJECTIVE: To assess the feasibility of implementing four patient decision aids (PtDAs) for early stage breast cancer treatment decisions into routine clinical care in community settings. BACKGROUND: There is very limited information available about implementing decision aids into routine clinical practice and most of this information is based on academic centres; more information is needed about implementing them into routine clinical practice in community settings. DESIGN: Structured individual interviews. SETTING AND PARTICIPANTS: Providers from 12 sites, including nine community hospitals, a community oncology centre and two academic centres. MAIN OUTCOME MEASURES: Usage data, barriers to and resources for implementing the PtDAs. RESULTS: Nine of the 12 sites were using the PtDAs with patients. All of the sites were lending the PtDAs to patients, usually without a formal sign-out system. The keys to successful implementation included nurses' and social workers' interest in distributing the PtDAs and the success of the lending model. Barriers that limited or prevented sites from using the PtDA included a lack of physician support, a lack of an organized system for distributing the PtDAs and nurses' perceptions about patients' attitude towards participation in decision making. CONCLUSIONS: It is feasible to implement PtDAs for early stage breast cancer into routine clinical care in community settings, even with few resources available.