School of Medicine and Public Health, University of Wisconsin, Madison, WI.
HealthDecision Founder, Madison, WI.
JCO Oncol Pract. 2023 Jan;19(1):e1-e7. doi: 10.1200/OP.22.00355. Epub 2022 Sep 20.
Implementing shared decision making (SDM), recommended in screening mammography by national guidelines for women age 40-49 years, faces challenges that innovations in quality improvement and team science (TS) are poised to address. We aimed to improve the effectiveness, patient-centeredness, and efficiency of SDM in primary care for breast cancer screening.
Our interdisciplinary team included primary and specialty care, psychology, epidemiology, communication science, engineering, and stakeholders (patients and clinicians). Over a 6-year period, we executed two iterative cycles of plan-do-study-act (PDSA) to develop, revise, and implement a SDM tool using TS principles. Patient and physician surveys and retrospective analysis of tool performance informed our first PDSA cycle. Patient and physician surveys, toolkit use, and clinical outcomes in the second PDSA cycle supported SDM implementation. We gathered team member assessments on the importance of individual TS activities.
Our first PDSA cycle successfully generated a SDM tool called Breast Cancer Risk Estimator, deemed valuable by 87% of patients surveyed. Our second PDSA cycle increased Breast Cancer Risk Estimator utilization, from 2,000 sessions in 2017 to 4,097 sessions in 2019 while maintaining early-stage breast cancer diagnoses. Although TS activities such as culture, trust, and communication needed to be sustained throughout the project, shared goals, research/data infrastructure support, and leadership were more important earlier in the project and persisted in the later stages of the project.
Combining rigorous quality improvement and TS principles can support the complex, interdependent, and interdisciplinary activities necessary to improve cancer care delivery exemplified by our implementation of a breast cancer screening SDM tool.
实施国家指南推荐的 40-49 岁女性乳房 X 线筛查中的共同决策（SDM）面临着一些挑战，而质量改进和团队科学（TS）的创新正准备解决这些挑战。我们旨在提高初级保健中乳腺癌筛查的 SDM 的有效性、以患者为中心和效率。
我们的跨学科团队包括初级保健和专科医疗、心理学、流行病学、沟通科学、工程学和利益相关者（患者和临床医生）。在 6 年的时间里，我们执行了两个迭代的计划-执行-研究-行动（PDSA）周期，使用 TS 原则开发、修改和实施 SDM 工具。患者和医生的调查以及工具性能的回顾性分析为我们的第一个 PDSA 周期提供了信息。第二个 PDSA 周期的患者和医生调查、工具包使用和临床结果支持了 SDM 的实施。我们收集了团队成员对个别 TS 活动重要性的评估。
我们的第一个 PDSA 周期成功地生成了一个称为乳腺癌风险评估器的 SDM 工具，87%接受调查的患者认为它有价值。我们的第二个 PDSA 周期增加了乳腺癌风险评估器的使用次数，从 2017 年的 2000 次增加到 2019 年的 4097 次，同时保持了早期乳腺癌的诊断。尽管在整个项目中需要维持 TS 活动，如文化、信任和沟通，但在项目的早期阶段，共同目标、研究/数据基础设施支持和领导力更为重要，并且在项目的后期阶段仍然存在。
将严格的质量改进和 TS 原则结合起来，可以支持改善癌症护理服务所需的复杂、相互依存和跨学科活动，这在我们实施乳腺癌筛查 SDM 工具中得到了体现。
