Article Title

Implementation of an Evidence-Based Breast Cancer Support Tool for Newly Diagnosed Breast Cancer Patients as Standard Care at Two Institutions: Use and Sustainability

Publication Date



implementation, breast cancer


Background/Aims: The Comprehensive Health Enhancement Support System (CHESS) was created to answer the need for information and support and to improve the quality of life of breast cancer patients. CHESS has been validated in several randomized trials. The aim of the current study is to implement CHESS as part of standard care at two Denver health care systems. All women who received a breast cancer diagnosis were offered access to CHESS during or very shortly after notification of their diagnosis and throughout the treatment process to provide information and decision-making support.

Methods: From July 2012 to July 2013, all newly diagnosed breast cancer patients at both institutions were offered CHESS. Two months postdiagnosis, CHESS users and non-users were randomized to no contact or to complete a telephone survey or interview about CHESS. Patient use of CHESS was tracked on the system server. In-depth interviews also were conducted with providers of both institutions after CHESS had been in use for one year. Providers were asked about organizational changes affecting CHESS implementation and sustainability, and potential to sustain CHESS after study completion.

Results: All patients were offered CHESS at least once, most often by nurses responsible for delivering the diagnosis. Overall, 24% of patients used CHESS by 2 months postdiagnosis. Users who liked CHESS said it was a safe and structured place to get needed information. For others, providing a username and password was a barrier to CHESS use. Providers liked having the CHESS resource to give patients; however, some felt that resources required for sustainability might be best used elsewhere. Other providers felt that CHESS should be sustained and expanded throughout each organization because of the potential impact for the women who preferred to use Web-based resources. Providers also felt that no Web-based resource could replace individual interactions with patients.

Discussion: Patients who liked CHESS felt it was helpful and appreciated the resource. Providers liked having CHESS to offer patients. Some providers felt CHESS should be maintained and expanded, while others felt it was no longer unique. Various resources may be necessary to meet patient and provider needs.




April 1st, 2015


April 28th, 2015