What does it take to have sustained use of decision aids? A programme evaluation for the Breast Cancer Initiative

Background: The Breast Cancer Initiative (BCI) was started in 2002 to disseminate breast cancer decision aids (PtDAs) to providers.

Methods: We analysed BCI programme data for 195 sites and determined the proportion of sites involved in each of five stages of dissemination and implementation of PtDAs. We conducted cross-sectional mail and telephone surveys of 79 sites with the most interest in implementation. We examined barriers associated with sustained use of the PtDAs.

Results: Since 2002 we attempted contact with 195 sites to join the BCI. The majority indicated interest in using PtDAs 172 of 195 (88%), 93 of 195 signed up for the BCI (48%), 57 of 195 reported distributing PtDAs to at least one patient (57%), and 46 of 195 reported sustained use (24%). We analysed data from interviews with 59 of 79 active sites (75% response rate). The majority of providers 49 of 59 (83%) had watched the PtDAs, and 46 of 59 (78%) distributed them to patients. The most common barriers were lack of a reliable way to identify patients before decisions are made (37%), a lack of time to distribute the PtDAs (22%) and having too many educational materials (15%). Sites that indicated a lack of clinician support as a barrier were significantly less likely to have sustained use compared to sites that didn't (33% vs. 74%, P = 0.02).

Conclusions: Community breast cancer providers, both physicians and non-physicians, express a high interest in using PtDAs with their patients. About a quarter of sites report sustained use of the PtDAs in routine care.