1. Shared Decision Making in Breast Care
Please feel free to add your organisation’s logo in the title slide and add the name of your organisation at the bottom of every slide.
Shared Decision Making in Breast Care
Helen McGarrigle; CNS in Breast care
Cardiff and Vale Breast Centre, Llandough Hospital
Insert name of presentation on Master Slide

2. What were you trying to achieve?
We were trying to learn how to best implement shared decision making in breast care
Describe the aim of what you were trying to achieve when you set off in your improvement journey
Shared Decision Making in Breast Care

3. Why is it important?
Cardiff and Vale Breast care team aims to inform and involve patients in decisions about their care and treatment. We want to ensure that her decision is based on sound knowledge and congruent with her thoughts and beliefs
Why is this work important and worth the time and effort required to achieve your aim?
Shared Decision Making in Breast Care

4. How did you introduce your change
The Magic and the Breast team adapted a Decision Quality Measure (DQM) , From Sepucha et al (2007) to measure the patients knowledge, preferences, readiness to decide and their preferred choice of treatment, and introduced it using PDSA
Did you use PDSA (Plan-Do-Study-Act) cycles? If not how did you introduce your change?
Shared Decision Making in Breast Care

5. How did you measure the impact?
Comparing data pre and post consultations .
Comparing data pre and post the introduction of the option grid
Did you collect new data or use existing data?
Provide details of any quantitative or qualitative data you may have used to inform your work and measure its impact.
Shared Decision Making in Breast Care

6. Shared Decision Making in Breast Care
Measuring change in patients’ knowledge
Knowledge (Feb-May 2011)
Green bars show correct answers to knowledge questions.
Massive improvement over time.
Data highlighted issues with some questions (e.g. length of time in hospital – not clear), but also some areas where patients perhaps weren’t getting enough info (e.g. effect of radiotherapy).
Shared Decision Making in Breast Care 6

7. Shared Decision Making in Breast Care
Measuring improvement in patients’ knowledge
Knowledge (Feb 2011 – Jan 2012)
Improvements in knowledge scores are continuing over time.
Shared Decision Making in Breast Care 7

8. Readiness to decide, using DelibeRATE (Feb 2011 – Jan 2012)
Measuring patients’ “readiness to decide”
Readiness to decide, using DelibeRATE (Feb 2011 – Jan 2012)
DelibeRATE assesses patients “readiness to decide”: do they know the options, know the pros and cons… have they given it enough thought, are they ready to decide.
Massive difference between two time points. By the end of the home visit, patients are much more confident about their decision – which is linked to their choice of treatment….
Shared Decision Making in Breast Care 8

9. Choice of treatment (Feb 2011 – Jan 2012)
Measuring patients’ choice of treatment
Choice of treatment (Feb 2011 – Jan 2012)
After the diagnostic consultation there is a lot of variation between patients – many are unsure which option to choose.
By the end of the home visit, hardly anyone is unsure… suggesting that patients are confident in their choice of treatment.
Shared Decision Making in Breast Care 9

10. Patients’ knowledge post diagnostic consultation
Measuring impact of change in clinical practice
Patients’ knowledge post diagnostic consultation
Here you can see the difference in knowledge at the end of diagnostic consultation between the first and second sets of data.
Massive improvement between two sets of data.
A few possible explanations:
Small numbers
Particularly intelligent group of patients ;-)
Team galvanised by seeing first set of data
Option Grid
The only two questions that the majority of patients are still not getting right – effect of radiotherapy on breast size and length of time for radiotherapy – are NOT included in the Option Grid.
Shared Decision Making in Breast Care 10

11. What resources/tools did you use?
We used the DQM questionnaire and an Option Grid
What tools or technique did you use/develop?
Bring examples (if possible) so delegates can see/take away, and learn from your experience.
If you wish to provide handouts /references/examples of tools during your session, please send them to by Friday 4th may who will make sure enough copies for all delegates will be available on the day.
Shared Decision Making in Breast Care

12. What was the outcome?
The breast care nurses (BCNs) use the DQM1 answers to inform our home visit. BCNs use DQM2 to check patients understanding and alignment between pts preferences and choices. BCNs can use the Data to provide evidence for the value of their role and the home visit
What did you achieve?
How do you know that your change resulted in an improvement and the delivery of patient driven care
If possible, provide evidence of the impact of your work, this could be using charts, stories, quotes etc
Shared Decision Making in Breast Care

13. When and how to spread? Spread at organisation level
When teams are ready and feel they own the idea
Show it working
One of the most significant challenges of Quality Improvement projects is knowing when to move from testing a change, to implementation and then to wider scale spread. Often great ideas get hidden within a corner of the organisation, or there are islands of excellence but no constituency.
Bearing this in mind , have you considered your spread strategy and if so what does this look like? What key factos made this or will make this succeed elsewhere?
Shared Decision Making in Breast Care

14. What three things could you do tomorrow
Consider using shared decision making in your setting.
Look at the “Ask 3 questions” campaign
Consider the use of option grids
Consider three practical things around compassionate care that delegates could do tomorrow to start testing your approach?
Suggest three things/actions that delegates can work with during the action planning session to apply the lessons from your presentation in their own area.
Please remember we are asking you to consider a “small scale ” test of changes that the teams might find will help them to get started.
Shared Decision Making in Breast Care