Abstract P4-04-02: Implementing Decision Aid Use and Shared-Decision Making in Breast Cancer Screening: A Scoping Review

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Abstract Background & Objective: International guidelines vary in recommendations on the starting age for mammography screening for women at average breast cancer risk; however, all note the importance of shared-decision making (SDM) from age 40 and older. Decision Aids (DAs) are evidence-based materials demonstrated to facilitate SDM and improve decisional conflict. The integration of SDM/DA into routine clinical practice is crucial to support patient-informed choice; however, little is known related to the implementation of SDM and/or DA into the clinical setting. Methods: This scoping review was conducted according to JBI guidelines and reported using PRISMA-ScR. [RF1] Nine bibliographic databases were searched from January 2010 to May 2023 to identify studies using any SDM and/or DA tool or intervention used to implement SDM/DA regarding breast cancer screening. The studies could target either care providers or women at average risk of developing breast cancer and must include at least one implementation outcome (acceptability, adoption, appropriateness, fidelity, feasibility, penetration, sustainability). Studies that focused primarily on the decision-making process were included, whereas those that aimed only to increase breast cancer screening were excluded. Study selection and data extraction were conducted using Covidence with two independent reviewers using the Oxford Implementation Index. We extracted information on study design, intervention details, primary outcome of the study, frameworks used to develop DAs, and all results related to implementation outcomes[MN2] . Each study was coded as efficacy, effectiveness, or implementation. Intervention strategies were coded using Expert Recommendations for Implementing Change (ERIC) and strategies used to change clinical behaviours and support implementation outcomes were coded using Behaviour Change Techniques (BCTs). Results: The search yielded 10,383 records of which 22 studies met the inclusion criteria, 2 targeting providers, 16, targeting patients, and 4 targeting both. Studies were classified as follows (provider cohort; patient cohort): efficacy studies (0/6, 0%; 8/20, 40%), effectiveness studies (4/6, 67%; 10/20, 50%), and primary implementation studies (1/6, 17%; 1/20, 5[MN3] %). In the provider cohort, acceptability was assessed in 6/6(100%), adoption in 2/6(33%), feasibility in 2/6(33%), appropriateness in 1/6(17%), and sustainability in 1/6(17%). In the patient cohort, acceptability was assessed in 20/20(100%), feasibility in 3/20(15%), appropriateness in 3/20(15%), adoption in 1/20(5%). In both cohorts, acceptability was the most evaluated implementation outcome(100%), while penetration and fidelity were never assessed. DAs demonstrated moderate-to-excellent acceptability, requiring the use of visual aids and plain language to facilitate understanding in patients. BCTs commonly employed to increase SDM/DA included shaping knowledge, natural consequences, and comparison of outcomes. ERIC strategies frequently used included developing and distributing educational materials; there were limited strategies related to increasing uptake amongst clinical providers. Common barriers to SDM/DA use in the provider cohort included time constraints and lack of SDM training. Conclusions: DAs are effective in assisting with SDM related to breast cancer screening and existing DA’s in the literature appear acceptable; however, these tools/techniques can only help if they are used as intended. More primary implementation studies, focused on implementation fidelity, adoption/penetration, and sustainability are required, especially targeting providers, to evaluate and understand the optimal strategies for implementation of SDM and DA in these healthcare settings. Citation Format: Rama Alkhaldi, Neha Pathak, Victoria Mintsopoulos, Rouhi Fazelzad, Sarina Schrager, Patricia Villain, Noah Ivers, Michelle B. Nadler. Implementing Decision Aid Use and Shared-Decision Making in Breast Cancer Screening: A Scoping Review [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-04-02.

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