The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA.
The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA.
BMJ Open. 2016 Feb 2;6(2):e010008. doi: 10.1136/bmjopen-2015-010008.
Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer.
Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3).
Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics.
In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer.
The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org).
We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews.
After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3.
Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast cancer found the Picture Option Grid usable, acceptable and accessible.
患有早期乳腺癌的社会经济地位（SES）较低的女性在决策、治疗和结果方面存在差异。有证据表明，当决策辅助工具根据患者的需求进行定制时，它们可以使服务不足的患者受益。我们的目的是开发和测试针对社会经济地位较低的早期乳腺癌女性的可视化医患交流决策辅助工具的可用性、可接受性和可及性。
基于社区的参与性研究（CBPR），使用出声思考协议（第 1 阶段和第 2 阶段）和半结构化访谈（第 3 阶段）。
服务不足的社区环境（如针织小组、宾果游戏厅、老年人中心）和乳腺诊所。
在第 1 阶段，我们招募了一组方便的临床医生和学者。在第 2 阶段，我们的目标是年龄在 40 岁以上、SES 较低、无论是否有乳腺癌病史的女性，在第 3 阶段，我们的目标是 SES 较低、最近被诊断患有乳腺癌的女性。
可视化医患交流决策辅助工具源自比较乳腺癌治疗选择的循证表格（http://www.optiongrid.org）。
通过出声思考协议和半结构化访谈，我们评估了原型可视化决策辅助工具的可用性、可接受性和可及性。
使用 CBPR 方法和迭代用户测试周期提高了可用性和可及性，并根据多方利益相关者的反馈开发和测试了 Picture Option Grid，完全由 Picture Option Grid 指导。所有最近被诊断患有早期乳腺癌的 SES 较低的女性都发现 Picture Option Grid 具有易用性、可接受性和可及性。
