Implementing decision and communication aids to facilitate patient-centered care in breast cancer: A case study

Objective

Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care.

Methods

We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions.

Results

The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test.

Conclusion

This case illustrates how decision support interventions can be deployed to promote patient-centered care.

Practice implications

Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries.