Moderated Poster

Poster, Podium & Video Sessions

MP69-18: A patient-centered practice change: Finding the best approach for prostate cancer decision support

Monday, May 15
7:00 AM - 9:00 AM
Location: BCEC: Room 153

Presentation Authors: Donna Berry*, Barbara Halpenny, Meghan Underhill, Boston, MA, Martin Sanda, Viraj Master, Christopher Filson, Atlanta, GA, Peter Chang, Boston, MA, Gary Chien, Los Angeles, CA, Seth Wolpin, Seattle, WA

Introduction: Implementation of evidenced-based patient-centered care is challenging in clinical settings. Success of such practice changes varies. The purpose of our study was to evaluate implementation strategies to deploy a shared decision aid for localized prostate cancer (LPC).

Methods: The Personal Patient Profile-Prostate (P3P) is a web-based decision aid with demonstrated efficacy in reducing decisional conflict among men choosing a care plan for LPC. Implementation strategies were co-designed with leaders in six geographically-diverse urology clinics. As part of routine care, men were informed of P3P and offered access via a variety of methods. Physicians received 1-page summaries of P3P patient-generated reports of current symptoms and factors influencing the care decision. Focus groups including physicians, clinic staff and administrators were held at each site to solicit feedback after the implementation period. Access metrics were monitored for up to 6 months. General impressions, common barriers and promoters were identified and synthesized from the focus group data.

Results: Two sites chose written information only to inform men of P3P, 1 site chose email only, 1 site chose email plus phone contact, 1 site chose MD instruction to use, followed by phone and email follow up and 1 site chose in clinic only. Barriers common to all settings included creating new workflows on top of heavy workloads, and staff and administrator misunderstanding of P3P context and resources. Staff inability to identify men with new LPC (vs follow up visits) hampered access. Promoters to successful implementation included an identified clinical lead, physician engagement and phone combined with email contact. Of all men with LPC seen in the clinics, 51% (range 15-98%) were informed of P3P. The highest rates of P3P access outside of clinic and prior to the consult visit (82, 73%) were observed when 2-3 modes of informing were implemented: physician, email and phone invitations. Clinic sites that chose to only provide written material with instruction to access P3P had the lowest access rates (range 0-14%). Physicians appraised the summaries as useful and helpful.

Conclusions: Despite challenges for clinic staff to add strategies to implement P3P to already heavy workloads, success was realized when physicians engaged and when staff provided follow up contacts to encourage P3P access. New practice changes to implement an evidence-based intervention require multi-modal strategies for early success. Future trials evaluating methods to reduce clinical workload may be of value.

Source Of Funding: NIH 5R01NR009692

Donna L. Berry, PhD, RN, FAAN

Harvard Medical School

Dr. Donna L. Berry is Director of the Phyllis F. Cantor Center for Research at the Dana-Farber Cancer Institute and an Associate Professor of Medicine at Harvard Medical School. Dr. Berry practiced as an oncology nurse specialist prior to receiving her PhD from the University of Washington in Seattle in 1992.
Dr. Berry leads several studies to improve the human experience of having a cancer diagnosis, ranging from making treatment decisions to managing cancer symptoms and side effects.
In 2011, Dr. Berry was the recipient of the Distinguished Researcher Award from the Oncology Nursing Society. The Association of Community Cancer Centers named her as the 2012 recipient of their Annual Clinical Researcher Award. In 2014, Dr. Berry received the President’s Award from the Friends of the National Institute of Nursing Research.

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