New technologies to support the decisions of women facing surgical choices for breast cancer: the reactions and concerns of health professionals

BACKGROUND: Women with breast cancer are frequently offered choices between breast conservation surgery and mastectomy. The BresDex study aims to develop and field-test a web-based patient Decision Support Technology for women diagnosed with breast cancer who are offered surgical treatment options. PURPOSE: To explore specialist breast team clinician opinions of the design and acceptability of Decision Support Technologies for women with breast cancer. METHODS: Research Ethics Committee approved study conducted in three specialist breast units of a UK region. Semi-structured interviews were conducted with 23 clinicians (breast surgeons, breast care nurses, oncologists and opinion leaders). Interviews were digitally recorded, transcribed verbatim and analysed using the framework approach. RESULTS: Clinicians consider Decision Support Technologies to have a potentially beneficial role in facilitating patient-based decision making, through the provision of additional information and decision support to that provided by breast teams. Some expressed concerns regarding Decision Support Technologies, specifically; the potential to overwhelm patients with information; the ability of a computerised tool to adequately tailor to patient needs; the potential for inconsistency between Decision Support Technology and breast team information (detail and available treatment options); and clinical time diversion towards tool use. Breast care nurses specifically expressed concern that Decision Support Technologies could devalue or replace their role. Reactions to Decision Support Technologies (positive and negative) appeared to cluster by breast team and clinician role. CONCLUSIONS: Willingness to implement a Decision Support Technology seemed to vary between teams. Team variables will be a critical factor for successful implementation into routine practice.