Feasibility of Providing Web-Based Information to Breast Cancer Patients Prior to a Surgical Consult
Patients facing decisions for breast cancer surgery commonly search the internet. Directing patients to high-quality websites prior to the surgeon consultation may be one way of supporting patients’ informational needs. The objective was to test an approach for delivering web-based information to breast cancer patients. The implementation strategy was developed using the Replicating Effective Programs framework. Pilot testing measured the proportion that accepted the web-based information. A pre-consultation survey assessed whether the information was reviewed and the acceptability to stakeholders. Reasons for declining guided refinement to the implementation package. Eighty-two percent (309/377) accepted the web-based information. Of the 309 that accepted, 244 completed the pre-consultation survey. Participants were a median 59 years, white (98%), and highly educated (>50% with a college degree). Most patients who completed the questionnaire reported reviewing the website (85%), and nearly all found it helpful. Surgeons thought implementation increased visit efficiency (5/6) and would result in patients making more informed decisions (6/6). The most common reasons patients declined information were limited internet comfort or access (n = 36), emotional distress (n = 14), and preference to receive information directly from the surgeon (n = 7). Routine delivery of web-based information to breast cancer patients prior to the surgeon consultation is feasible. High stakeholder acceptability combined with the low implementation burden means that these findings have immediate relevance for improving care quality.
KeywordsImplementation Decision support Breast cancer surgery Web-based information Internet
Compliance with Ethical Standards
Eligible patients were then offered the study by the nursing staff or breast cancer navigator either at the time of diagnosis or when their appointment in the surgery clinic was made, and oral consent was obtained. The study protocol was approved by the UW Human Subjects Committee and all participants gave informed consent.
The project was funded by the Building Interdisciplinary Research Careers in Women’s Health Scholar Program (NIH K12 HD055894). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. It was also supported in part by the University of Wisconsin Carbone Cancer Center through NIH/NCI P30 CA014520- UW Comprehensive Cancer Center Support and the Mentored Training for Dissemination and Implementation Research in Cancer fellowship (R25CA171994).
- 1.Fox S, Duggan M. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/. Accessed 14 Mar 2016
- 3.McLeod J, Yu I, Ingledew PA (2016) Peering into the deep: characterizing the internet search patterns of patients with gynecologic cancers. J Cancer EducGoogle Scholar
- 8.Neuman HB, Cabral C, Charlson ME, Temple LK (2007) Is internet information adequate to facilitate surgical decision-making in familial adenomatous polyposis? Dis Colon rectum 50(12):2135–2141Google Scholar
- 9.Wasserman M, Baxter NN, Rosen B, Burnstein M, Halverson AL (2014) Systematic review of internet patient information on colorectal cancer surgery. Dis Colon rectum 57(1):64–69Google Scholar
- 10.Kohler BA, Sherman RL, Howlader N, et al. (2015) Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107(6):djv048Google Scholar
- 13.O’Connor AM, Llewellyn-Thomas HA, Flood AB (2004) Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood). Suppl Variation:VAR63–72Google Scholar
- 17.Waltz TJ, Powell BJ, Matthieu MM et al (2015) Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci 10(1):109CrossRefPubMedPubMedCentralGoogle Scholar
- 21.O’Connor AM, Cranney A. User manual—acceptability. 1996. http://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Acceptability.pdf. Accessed 12 July 2013
- 23.Perrin A, Duggan M (2015) Americans’ Internet access: 2000–2015. Pew Research CenterGoogle Scholar