Background: To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. Methods: Implementation and participation rates and patients’ BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs’ perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. Results: The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n= 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. Discussion: When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.
背景：为提升个性化治疗后监测的共享决策（SDM）水平，本研究开发并整合了个性化风险信息的乳腺癌监测决策辅助工具（BCS-PtDA），并在八家医院实施。这项混合方法研究旨在：（1）评估实施率与参与率，（2）识别医疗专业人员使用该工具时的促进因素与障碍，（3）量化观察到的SDM水平，（4）评估咨询中的风险沟通与SDM应用情况。方法：通过医院登记数据和BCS-PtDA日志数据计算实施率、参与率及患者使用情况；采用MIDI框架收集医疗专业人员对使用促进因素与障碍的反馈；使用OPTION-5量表量化咨询记录中的SDM水平；通过主题分析法评估咨询内容。结果：平均PtDA实施率与参与率分别为26%和61%。医疗专业人员反馈PtDA有助于提升决策意识，而实施障碍主要来自工作量增加和感知获益不足。对64例咨询的分析显示，患者虽获得选择机会但缺乏深入讨论，风险沟通总体充分。讨论：使用BCS-PtDA时患者能明确获得治疗后监测的选择权，但信息提供与SDM应用仍有改进空间。
肿瘤(癌症)患者之家