Protocol implementation of Shared Decision Making in Dutch breast cancer care; a prospective process evaluation

Rationale: Practice variations in treatment of early-stage breast cancer should be determined by the preferences of well-informed patients. There is, however, substantial practice variation in type of surgery in breast cancer between Dutch hospitals. Involving patients in the decision making process is seen as an important strategy to reduce unwarranted variation in preference-sensitive care. In an earlier study, we developed a personalized patient decision aid, which was pilot tested in 4 hospitals. Based upon this pilot test, we adapted the implementation strategy. Currently, the decision aid is being implemented in the hospitals in the OncoZON region, and in the hospitals that had participated in the pilot study.


Objectives: The main aim of the current study is to further investigate implementation challenges, by investigating the actual implementation rate at several levels, by investigating barrieres and facilitators for implementation, and by investigating patient-experiences on shared decision making.
Study design: This study concerns an observational study, a prospective process evaluation of the implementation of the decision aid.


Study population: Patients with newly diagnosed breast cancer, stage I or II who are eligible for breast conserving therapy or mastectomy can be included. We expect that 5 hospitals will each include 30 patients in a period of 6 months. In addition, in each hospital, all breast surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, nurse practitioners and nurses taking part in the education and decision-making process are invited to participate in implementation of SDM.

Audits and interviews: immediately after implementation
Patient questionnaires: during implementation.

The intervention consists of offering patients a personalized patient decision aid.