Table 2 Example quotations according to sociotechnical dimensions, theme, and participant type
Sociotechnical Dimensions and Theme | Example Quotation: Patients | Example Quotation: Clinicians |
|---|---|---|
People | ||
Patient Clinician Communication · Help shared decision making between patients and providers. (10/22 participants) · Prepare better for their first appointment (8/10 participants) | “If you have any questions, you’d be more prepared for the doctor visit or at least have an idea of what you want so when you’re in there with the doctor, the patient can be more confident and say what they want or what they think they want and then start the conversation there with the doctor.” – Patient 28, implant reconstruction | “I think this [BREASTChoice Tool] is very helpful. These are a lot of the questions that people ask me, and it might bring up a little more of an informed, a guided discussion with some of this stuff.” – Clinician 40 |
Preference for Timing of BREASTChoice Summary • Receive the patient’s BREASTChoice summary right before the patient is seen (6/12 participants) · Print or email the summary. (6/12 participants) | “The way I generally approach my clinic is one patient at a time kind of thing. If it’s [BREASTChoice summary] an inbox thing that I need to read before I go see the patient, as long as it’s there and it’s easily accessible and relatively condensed information, I think that that’s okay. I don’t think that’ll disrupt much of anything. It may help because now I know what the patient’s thinking a little bit before you even get in there.” – Clinician 41 | N/A |
“Honestly, [receiving the summary] probably right before I see the patient. Not days in advance and not afterwards, but within that clinic day or immediately prior to walking in to have the conversation with the patient.” – Clinician 39 | ||
Workflow and Communication | ||
Location to View Tool • Patients prefer to use the tool at home (7/10 participants) · Clinicians indicated that patients could also benefit from using the tool in the waiting room prior to their appointment. (5/12 participants) | “I think I would probably prefer at home because I feel like I could really take the time to go through it, and then if I had questions from, I would just write any of that down and then take that into my doctor.” – Patient 20, flap reconstruction | “There’s a lot of waiting when they come to our clinics, so I think it makes sense to give them some—these sorts of tools are perfect because it triggers their line of questioning when they’re finally seen, and also it minimizes their annoyance that we’re behind.” -Clinician 45 |
Timeline to Use Tool • Beneficial for patients to use the tool prior to their plastic surgery appointment (16/22 participants) | “I wish I would have seen this before my first appointment with the surgeon. I felt like my first plastic surgery appointment, I thought it was just to do what we’re doing right now, to go over my options, to learn about what I can do, but in fact, it was the opposite.” – Patient 6, flap reconstruction | N/A |
Organizational Policies and Culture | ||
EHR Integration • Clinicians were unsure that EHR alerts were the best way to get the patient summary (3/12 participants) | N/A | “Someone’s got to get it [summary] to print it off and put it in my face or shoot me an email just before I see the patient. I’m going to be very honest when it comes to BPAs. I think we all just click dismiss. They’re nice, but I don’t think they’re the most effective. If there would be another way—will it be in the patient’s chart?” – Clinician 50 |
Hardware and Technical Infrastructure | ||
Tablet Computers • Helpful to provide patients with tablet computers to view the tool in the waiting room (5/12 participants) | N/A | “If they [patients] can get iPads or something like that or while in a waiting area for plastics, that’s something that they can fill out because I think it would be really helpful for the patients.” – Clinician 45 |
Innovation Content | ||
Design · Most liked the design and thought the color scheme was appropriate and the tool was user friendly (19/22 participants) · Some found the tool to be a little “text heavy” and preferred content be easier to read and digest (14/22 participants) | “I think it’s [BREASTChoice tool] very clear. It’s not too wordy. It’s got just the right amount of information. No. I think definitely it’s not too busy. Sometimes there’s so much on a screen that you don’t even know where to go.” – Patient 16, implant reconstruction | “I think it’s simple, straightforward. I think it’s easy to navigate. I think my overall impression is that I’ve read a lot of words. I think if you could have some sort of way to relieve some of that, just the wordiness of it. This is all very, very important information, but I’m just not sure how many people are going to actually pay attention to all of these details, whereas if you have someone lay it for you or speak you through it or talk you through it, I think a lot of the comprehension may be a little bit better.” – Clinician 40 |
Diagram · Gave patients a better understanding of the reconstruction procedures (17/22 participants) · Diagrams could have been more beneficial to clinicians if they were less cartoon-like and more realistic (8/12 participants) | “I think this picture [of implants] is really good…for understanding really how it’s put in place…how the implant works.” – Patient 24, implant reconstruction “Just showing where they’re taking the tissue from, the skin and stuff that’s helpful because if you just said latissimus dorsi flap, nobody would know what you were talking about.” – Patient 16, implant reconstruction | “So I don’t think it’s—it’s not the best picture I’ve seen. And it’s very cartoonish. I guess I don’t love the drawings.” – Clinician 202 |
Layout of Content · Information presented in a way patients would be able to understand (17/22 participants) | N/A | “I think that the format it’s laid out in [BREASTChoice Tool] is actually really nice, just kind of how from the beginning to now with listing the delayed, immediate, and now you’re getting into the actual reconstruction itself with the implants. Again, I’m a big fan of this. It gives the pros and cons just bulleted and just more to the point.” – Clinician 48 |
Length of Tool · Length was manageable (20/22 participants) | N/A | “This is a topic that I think the women will be very engaged in. It’s [length] not overwhelming at all, and it’s presented in nice, short packets that I think are very manageable.” – Clinician 37 |
Human Computer Interaction | ||
Tool Navigation · Easy to navigate (20/22 participants) · Appreciated the ability to travel back and forth between pages (13/22 participants) Risk Profile Navigation · Navigating the risk profile tool can be confusing due to the amount and layout of information on the page (10/22 participants) · Risk profile assessment illustrates the risks associated with different forms of reconstruction (6/10 participants) | “I like that, after each page, there’s an arrow to direct you to the next. I like that they’re not long pages either, which I think will be good for a lot of patients if they’re navigating this as an older group, just to keep it short and sweet because, sometimes, you just get so overwhelmed with information that you’re not actually absorbing anything because of all the emotions too.” – Patient 14, flap reconstruction “On this page, when you first start reading it, you have to scroll down a little bit to be able to see the other parts. When I first see it, I think it distracts me from the reading, and I look over to see what this is about or what this is for. What are all these people over here for? I think it’s a good visual. It’s just what shows up on your screen and having to scroll through. They may skip some of the reading or be distracted by it at first.” – Patient 23, flap reconstruction “I had no clue what my chances were of having any kind of infection or anything or tissue damage or anything like that, so I think that that it’s nice to know for people looking into it what their chances are of having it.” – Patient 7, implant reconstruction “Just reading top to bottom, it’s like, you have a risk level of X. Where’s my risk level coming from? It’s (risk profile page) a little hard to figure it out at first. If you don’t read everything there, then you might be confused on how it’s working.” – Patient 24, implant reconstruction | N/A |