Physician Behaviors Surrounding the Implementation of Decision and Communication Aids in a Breast Cancer Clinic: a Qualitative Analysis of Staff Intern Perceptions
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The aim of this paper is to examine how physician behavior facilitated or impeded our implementation of decision and communication aids in a breast cancer clinic. Staff interns provided decision and communication aids to patients and wrote up case notes for each patient they served. We used grounded theory to code our staff interns’ case notes. We then identified barriers and facilitators to our program’s implementation from each category we generated in the coding. Facilitators included physicians reading patient questions and then bringing the staff interns to the consultation. Barriers included physicians forgetting to bring the staff interns to the appointments and discouraging interns from speaking during the consultation. Physicians vary in their cooperation with our program. Our next steps will be to inquire directly with physicians about how to adapt our program design. We will also seek to position the staff interns as mentees to increase physician commitment to our program.
KeywordsImplementation Shared decision making Decision aids Communication aids
We would like to thank the patients who received our services, as well as the staff interns who delivered the services and reflected in their case notes. Thanks also to the physicians who agreed to have the staff interns attend the appointments as part of our patient support program. We thank Meredith Buxton, MPH, Research Director at the Breast Care Center for her role in administering the overall staff internship program. Thanks to Dan Dohan, PhD for his advice regarding methodology and to Rebecca Howe for her feedback. Thanks also to Gloria Won and the rest of the staff of the H.M. Fishbon Library at UCSF for their help reviewing literature. We are grateful to the Informed Medical Decisions Foundation for funding this work.
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