Pérez-Lacasta, M.J. (María José)
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- Barriers and facilitators to the implementation of a personalized breast cancer screening program: views of spanish health professionals(2022) Laza-Vásquez, C. (Celmira); Hernández-Leal, M.J. (María José); Pérez-Lacasta, M.J. (María José); Carles-Lavila, M. (Misericordia); Rué, M. (Montserrat); Cruz-Esteve, I. (Inés)This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.
- Development of support material for health professionals who are implementing Shared Decision-making in breast cancer screening: validation using the Delphi technique(2022) Codern-Bové, N. (Núria); Vidal-Lancis, C. (Cármen); Hernández-Leal, M.J. (María José); Pérez-Lacasta, M.J. (María José); Cardona, Á. (Ángeles); Carles-Lavila, M. (Misericordia)Background The Literature is no report support material on Shared Decision-making applied to breast cancer screening that is intended for Spanish health professionals. The researcher created both a handbook and a guide for this topic using an adaption of the Three-talk model. Objective A Delphi method will be used to reach an agreement among experts on the contents and design of a manual and guide, designed by the research team, and to be used by health professionals in the application of SDM in breast cancer screening. Design A qualitative study. The content and design of the handbook and the guide was discussed by 20 experts. The Delphi techniques was in an online mode between July and October 2020 and researchers used Google forms in three rounds with open and closed questions. The criterion established for consensus was a coefficient of concordance (Cc) above 75, for questions using a Likert scale of 1¿6¿in which 1 meant `completely disagree¿ and 6 `completely agree¿¿with a cut-off point equal to or higher than 4. Results Participants considered the Three-talk model suitable for the screening context. The handbook sections and level of detail were considered satisfactory (Cc=90). The summary provided by the clinical practice guide was considered necessary (Cc=75), as it was the self-assessment tool for professionals (Cc=85). Content was added: addressing the limitations of the SDM model; extending the number of sample dialogues for health professionals; providing supplementary resources on using Patient Decisions aids and adding references on communication skills. Conclusions and applications The first handbook and clinical practice guide providing unique SDM support material for health professionals have been developed. The handbook and guide are useful and innovative as supporting material for health professionals, but training strategies for SDM and a piloting plan for the use of materials are requested, in order to facilitate its implementation.
- Womens preference to apply shared decision-making in breast cancer screening: a discrete choice experiment(2022) Codern-Bové, N. (Núria); Vidal-Lancis, C. (Cármen); Hernández-Leal, M.J. (María José); Pérez-Lacasta, M.J. (María José); Cardona, Á. (Ángeles); Carles-Lavila, M. (Misericordia); Rué, M. (Montserrat); Forné, C. (Carles)Objective: To analyse women's stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer screening programmes (BCSP). DesignA discrete choice experiment was designed with 12 questions (choice tasks). It included three attributes: 'How the information is obtained', regarding benefits and harms; whether there is a 'Dialogue for scheduled mammography' between the healthcare professional and the woman; and, 'Who makes the decision', regarding participation in BCSP. Data were obtained using a survey that included 12 choice tasks, 1 question on WTP and 7 socioeconomic-related questions. The analysis was performed using conditional mixed-effect logit regression and stratification according to WTP. SettingData collection related to BCSP was conducted between June and November 2021 in Catalonia, Spain. ParticipantsSixty-five women aged between 50 and 60. Main outcome measuresWomen's perceived utility of each attribute, trade-off on these attributes and WTP for SDM in BCSP. ResultThe only significant attribute was 'Who makes the decision'. The decision made alone (coefficient=2.879; 95% CI=2.297 to 3.461) and the decision made together with a healthcare professional (2.375; 95% CI=1.573 to 3.177) were the options preferred by women. The former contributes 21% more utility than the latter. Moreover, 52.3% of the women stated a WTP of Euro10 or more for SDM. Women's preferences regarding attributes did not influence their WTP.ConclusionsThe participant women refused a current paternalistic model and preferred either SDM or informed decision-making in BCSP.
- Advances in shared decision-making for breast cancer screening in Spain(2022) Hernández-Leal, M.J. (María José); Pérez-Lacasta, M.J. (María José); Carles-Lavila, M. (Misericordia)One of the most recent goals of health programmes in many countries is developing a person-centred healthcare model; however, strategies to implement it are still scarce, especially in health contexts such as preventive medicine. In the context of screening programmes, Shared Decision Making (SDM) can be a good alternative. Research has been carried out in Spain to understand both the local and international situation through systematic reviews and initiatives ranging from: the creation of Decision Aid (DA) support tools; the measuring of their effects on users¿ knowledge of the screening risks and benefits; the writing of manuals for healthcare professionals; the assessment of the patient¿s satisfaction in this type of relationship with the healthcare professional and, the efficiency of including SDM in a new way of conducting the screening programme. Nevertheless, efforts have not ensured yet its applicability as a routine practice in the clinical encounter and therefore, innovations and studies are still being conducted to make it real.