Durand Marie-Anne, Bannier Marie, Aim Marie-Anastasie, Mancini Julien
CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.
The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Lebanon, Lebanon, NH, USA.
Patient Prefer Adherence. 2023 Oct 4;17:2463-2474. doi: 10.2147/PPA.S421695. eCollection 2023.
After a diagnosis of early-stage breast cancer, women of lower socioeconomic position (SEP) report worse outcomes than women of higher SEP. A pictorial conversation aid was shown to improve decision outcomes in controlled contexts. No such intervention existed in France. In Phase 1, our aim was to adapt, for use in France, two pictorial conversation aids for breast cancer surgery and reconstruction. In Phase 2, our aim was to implement them in a regional cancer center serving a diverse population.
In phase 1, we used iterative qualitative methods to adapt the conversation aids with a convenience sample of patients and health professionals. In phase 2, we tested their implementation using PDSA cycles with volunteer surgeons.
In phase 1, we interviewed 10 health professionals and 5 patients to reach thematic data saturation. They found the conversation aids usable and very acceptable (especially patients) and suggested small changes to further simplify the layout and content (including a glossary). In phase 2, three surgeons started the first PDSA cycle, for 4 weeks. Only one additional surgeon agreed to take part in the second cycle. The third cycle was cancelled since no new surgeon agreed to take part. Time was a barrier for 2 out of 4 surgeons, potentially explaining the difficulty recruiting for the third cycle. The evaluation was otherwise positive. The surgeons found the conversation aids very useful during their consultations and all intended to continue using them in the future.
It was possible to adapt, for use in France, pictorial conversation aids proven to be effective elsewhere. While the adapted conversation aids were deemed usable by health professionals and very acceptable to patients, their implementation using PDSA cycles proved slow.
在被诊断为早期乳腺癌后，社会经济地位较低的女性报告的治疗结果比社会经济地位较高的女性更差。在对照环境中，一种图片对话辅助工具被证明可以改善决策结果。在法国，尚无此类干预措施。在第一阶段，我们的目标是对两种用于乳腺癌手术和重建的图片对话辅助工具进行改编，以便在法国使用。在第二阶段，我们的目标是在一个服务于多样化人群的地区癌症中心实施这些工具。
在第一阶段，我们使用迭代定性方法，通过方便抽样的患者和卫生专业人员来改编对话辅助工具。在第二阶段，我们使用计划 - 实施 - 检查 - 处理（PDSA）循环对志愿外科医生进行测试，以评估其实施情况。
在第一阶段，我们采访了10名卫生专业人员和5名患者，以达到主题数据饱和。他们发现对话辅助工具可用且非常容易接受（尤其是患者），并建议进行一些小的修改以进一步简化布局和内容（包括一个术语表）。在第二阶段，三名外科医生开始了为期4周的第一个PDSA循环。只有另外一名外科医生同意参加第二个循环。由于没有新的外科医生同意参加，第三个循环被取消。时间是4名外科医生中的2名面临的障碍，这可能解释了招募第三个循环参与者的困难。不过，评估结果是积极的。外科医生们发现在会诊期间对话辅助工具非常有用，并且所有人都打算在未来继续使用它们。
有可能对在其他地方已被证明有效的图片对话辅助工具进行改编，以便在法国使用。虽然改编后的对话辅助工具被卫生专业人员认为可用且患者非常容易接受，但使用PDSA循环实施它们的过程证明进展缓慢。
