Facilitators for sustainable use of an in-consult patient decision aid in adjuvant treatment decisions for early stage colorectal cancer - From clinicians' perspective.

Abstract

Shared decision-making (SDM) and the use of patient decision aids (PtDAs) can enhance patient involvement in treatment decisions, yet sustainable implementation in clinical practice remains challenging. This study explores the sustained use of a paperbased PtDA, the DECISION HELPER™, in adjuvant chemotherapy consultations for patients with early-stage colorectal cancer at a Danish hospital. The colorectal cancer team expressed reluctance to discontinue using the tool during the testing of a digital pre-consult version. Using a hermeneutic phenomenological approach, two focus group interviews were conducted with seven physicians and four nurses from the Department of Oncology at Vejle Hospital, Denmark. All participants had intensive experience using the DECISION HELPER™ in consultations. Data were thematically analysed through inductive coding to identify factors supporting long-term integration of the tool. Two main themes were identified across both professional groups: (A) the DECISION HELPER™ functions as a pedagogical tool that facilitates patient involvement, and (B) it enhances patients' understanding of their own life situation. Clinicians emphasized the tool's role in visualizing complex choices, supporting structured communication, and enabling patients to regulate the amount of information received. Importantly, no significant differences were found between nurses' and physicians' perspectives, and the tool was experienced as enhancing professional practice and consistency in patient care. From the clinicians' perspective, the DECISION HELPER™ supported meaningful SDM. Its visual presentation of treatment options and structured consultation format helped make complex treatment choices tangible for patients and supported its sustained use in practice. The findings suggest that successful and sustainable use of patient decision aids may depend on tools that integrate naturally into clinical workflows while structuring the consultation process. Visualizing treatment options and outcomes and supporting conversations about patient values may help clinicians facilitate meaningful SDM and promote consistent patient-centered dialog in oncology care.