PMID- 21029281 OWN - NLM STAT- MEDLINE DCOM- 20110907 LR - 20211020 IS - 1369-7625 (Electronic) IS - 1369-6513 (Print) IS - 1369-6513 (Linking) VI - 14 IP - 2 DP - 2011 Jun TI - Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. PG - 133-46 LID - 10.1111/j.1369-7625.2010.00633.x [doi] AB - BACKGROUND: There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. OBJECTIVE: To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. METHODS: As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. RESULTS: A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. CONCLUSIONS: The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. CI - (c) 2010 Blackwell Publishing Ltd. FAU - Caldon, Lisa J M AU - Caldon LJ AD - Department of Oncology, University of Sheffield, Sheffield, UK. l.caldon@sheffield.ac.uk FAU - Collins, Karen A AU - Collins KA FAU - Reed, Malcolm W AU - Reed MW FAU - Sivell, Stephanie AU - Sivell S FAU - Austoker, Joan AU - Austoker J FAU - Clements, Alison M AU - Clements AM FAU - Patnick, Julietta AU - Patnick J FAU - Elwyn, Glyn AU - Elwyn G CN - BresDex Group LA - eng GR - MCCC-FCO-11-C/MCCC_/Marie Curie/United Kingdom GR - CRUK_/Cancer Research UK/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20101028 PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - *Attitude of Health Personnel MH - Breast Neoplasms/psychology/*surgery MH - *Decision Support Systems, Clinical MH - Female MH - Humans MH - Internet MH - Interviews as Topic MH - Male MH - Mastectomy/methods/*psychology MH - Patient Education as Topic/*methods MH - Physician-Patient Relations MH - Physicians/*psychology MH - United Kingdom PMC - PMC5060572 FIR - Edwards, Adrian IR - Edwards A FIR - Evans, Rhodri IR - Evans R FIR - Rogers, Veronica IR - Rogers V FIR - Day, T J IR - Day TJ FIR - Donald, Anne IR - Donald A EDAT- 2010/10/30 06:00 MHDA- 2011/09/08 06:00 PMCR- 2011/06/01 CRDT- 2010/10/30 06:00 PHST- 2010/10/30 06:00 [entrez] PHST- 2010/10/30 06:00 [pubmed] PHST- 2011/09/08 06:00 [medline] PHST- 2011/06/01 00:00 [pmc-release] AID - HEX633 [pii] AID - 10.1111/j.1369-7625.2010.00633.x [doi] PST - ppublish SO - Health Expect. 2011 Jun;14(2):133-46. doi: 10.1111/j.1369-7625.2010.00633.x. Epub 2010 Oct 28.