Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool

Background: BREASTChoice is a web-based decision tool about breast reconstruction after mastectomy. The current focused usability assessment was designed to elicit patients’ and clinicians’ perspectives on barriers and facilitators for implementing BREASTChoice into the clinical workflow. Methods: We conducted think-aloud protocols and qualitative interviews with patients and clinicians from two Midwestern medical centers from August 2020 to April 2021. We used the sociotechnical framework to evaluate BREASTChoice’s implementation and sustainability potential according to end-users, human-computer interaction, and contextual factors. Results: Twelve clinicians and ten patients completed interviews. Using the sociotechnical framework, we determined the following. People Using the Tool Patients and clinicians agreed that BREASTChoice could help patients make more informed decisions about their reconstruction, and prepare better for their first plastic surgery appointment. Workflow and Communications They felt that BREASTChoice could improve communication and the decision process if the patient could view the tool before the clinical visit. Clinicians suggested the information from BREASTChoice about patients’ risks and preferences be included in the patient’s chart or the clinician electronic health record (EHR) inbox for accessibility during the consultation. Human Computer Interface Patients and clinicians stated that the tool contains helpful information, does not require much time for the patient to use, and efficiently fills gaps in knowledge. Although patients found the risk profile information helpful, they reported needing time to read and digest it. Conclusion: BREASTChoice was perceived as highly usable by patients and clinicians and has the potential for sustainability. Future research will implement and test the tool after integrating the stakeholder-suggested changes to its delivery process and content. It is critical to conduct usability assessments such as these prior to decision tool implementation in order to improve workflow and risk communication.