1
|
Théberge J, Smithman MA, Turgeon-Pelchat C, Tounkara FK, Richard V, Aubertin P, Léonard P, Alami H, Singhroy D, Fleet R. Through the big top: An exploratory study of circus-based artistic knowledge translation in rural healthcare services, Québec, Canada. PLoS One 2024; 19:e0302022. [PMID: 38635538 PMCID: PMC11025836 DOI: 10.1371/journal.pone.0302022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. METHODS To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." RESULTS The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. CONCLUSION As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.
Collapse
Affiliation(s)
- Julie Théberge
- Laval University, Québec, Canada
- Research Chair in Emergency Medicine Université-CISSS-CA, Lévis, Canada
- VITAM Centre de recherche en santé durable, Québec, Canada
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
| | | | | | | | - Véronique Richard
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
- University of Queensland, Brisbane, Australia
| | - Patrice Aubertin
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
| | | | | | | | - Richard Fleet
- Laval University, Québec, Canada
- Research Chair in Emergency Medicine Université-CISSS-CA, Lévis, Canada
- VITAM Centre de recherche en santé durable, Québec, Canada
| |
Collapse
|
2
|
Yi M, Jia Y, Zhao B, Chen O. The Barriers to Shared Decision-making in Exercise Prescription for Children With Asthma: A Qualitative Study From Parents' Perspective. J Pediatr Health Care 2024:S0891-5245(24)00001-4. [PMID: 38310492 DOI: 10.1016/j.pedhc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The knowledge of barriers from the parental perspective is essential for facilitating shared decision-making in the field of pediatric asthma. METHOD Participants who were parents of children with a diagnosis of asthma were recruited, and in-depth, semistructured interviews were conducted. The interview transcripts were analyzed thematically using framework methods. RESULTS Seventeen participants undertook interviews. Three themes and nine subthemes emerged: (1) decision-making need level-limited understanding of decision-making knowledge, ambiguity regarding self-empowerment roles, and lack of family member support; (2) decision-making support level-insufficient ability to evaluate information, inefficient communication with health care professionals, and excessive use of professional terminology; and (3) decision-making outcome level-doubts about the final decision-making choices, time constraints on decision-making, and absence of mechanisms to track decisions made. DISCUSSION The findings would serve as crucial foundations for the development of decision-aid programs within the context of pediatric asthma.
Collapse
|
3
|
Bootsma JN, Phoenix M, Geytenbeek JJM, Stadskleiv K, Gorter JW, Fiske S, Cunningham BJ. Implementing the language comprehension test C-BiLLT: a qualitative description study using the COM-B model of behaviour change. BMC Health Serv Res 2022; 22:1421. [PMCID: PMC9702652 DOI: 10.1186/s12913-022-08803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
It is challenging to reliably assess the language comprehension of children with severe motor and speech impairments using traditional assessment tools. The Computer Based instrument for Low motor Language Testing (C-BiLLT) aims to reduce barriers to evidence-based assessment for this population by allowing children to access the test using non-traditional methods such as eye gaze so they can independently respond to test items. The purpose of this study is to develop a contextualized understanding of the factors that influenced clinicians’ implementation of the C-BILLT in practice in the Netherlands and Norway.
Materials and methods
A qualitative approach including semi-structured individual interviews with 15 clinicians (speech-language pathologists, neuropsychologists, and one teacher, counsellor, and vision specialist) was used. Data analysis was conducted in two rounds. First, a deductive approach including a codebook was used to code data within the COM-B components describing clinicians’ capability, opportunity, and motivation for behaviour change. Then, an abductive approach applying thematic analysis was used to identify meaningful patterns within the COM-B components.
Results
Several meaningful barriers and facilitators were identified across the data. Clinicians used the C-BiLLT with two distinct groups of clients: (1) the population it was originally developed for, and (2) clients that could have also been assessed using a traditional language test. Clinicians working with the first group experienced more, and more complex barriers across all COM-B components, to successful C-BiLLT use than the latter.
Conclusion
This study provides timely insights into the capability, opportunity, and motivation factors important for creating and sustaining assessment behaviour change in clinicians who used or attempted to use the C-BiLLT. Potential tailored intervention strategies aimed at improving implementation of novel assessment tools are discussed and may be helpful for others working to improve service delivery for children with complex needs.
Collapse
|
4
|
Berkowitz J, Martinez-Camblor P, Stevens G, Elwyn G. The development of incorpoRATE: A measure of physicians' willingness to incorporate shared decision making into practice. PATIENT EDUCATION AND COUNSELING 2021; 104:2327-2337. [PMID: 33744056 DOI: 10.1016/j.pec.2021.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To develop 'incorpoRATE', a brief and broadly applicable measure of physicians' willingness to incorporate shared decision making (SDM) into practice. METHODS incorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance. RESULTS The final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations. CONCLUSIONS incorpoRATE is a novel physician-reported measure that assesses physicians' willingness to incorporate SDM in practice. PRACTICE IMPLICATIONS incorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.
Collapse
Affiliation(s)
- Julia Berkowitz
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Pablo Martinez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
5
|
A Tripartite Knowledge Translation Program: Innovative Patient-Centered Approach to Clinical Research Participation for Individuals with Multiple Sclerosis. Mult Scler Int 2021; 2021:5531693. [PMID: 34327022 PMCID: PMC8310439 DOI: 10.1155/2021/5531693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/21/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Knowledge translation (KT) models that represent an individual's perspective are a sign of effective KT. Some common challenges in KT include participant engagement, organization of the team, and time demands of the participants. We implemented a unique tripartite KT program to (1) share current research, (2) inform persons living with multiple sclerosis (pwMS) about the clinical research process, and (3) invite pwMS to immediately participate in clinical research. The primary aim was to determine participants' perspectives on the value and acceptability of an experiential research program offered at a patient and family educational conference. Methods A team of researchers identified factors that would impact the logistics of hosting an experiential research program at a conference and designed a unique tripartite KT program. The local multiple sclerosis (MS) society was engaged to select an appropriate location and invite stakeholders to the conference. A survey to determine participants' perspectives on the value and acceptability of the experiential research program was developed and analyzed. Results 65 pwMS attended the conference, and 44 (67.7%) participated in the on-site experiential research program. 72.7% of the participants completed the survey, of which 93.8% stated that they strongly agree or agree with the following statements: "Did you feel like participating in research today was a valuable experience to you?" and "Did you feel like you were contributing to MS research?" 100% of the participants agreed or strongly agreed when asked "would you like to see more research activities taking place at these kinds of events?" Conclusions This paper describes the logistics and challenges of conducting an experiential KT program, which proved to be rewarding for pwMS. The majority of pwMS attending the conference agreed to participate in the on-site experiential research program and an overwhelming majority of participants felt the experience was valuable.
Collapse
|
6
|
Krishna Prasad GV. Shared decision making in peri-operative medicine: Miles to go in Indian scenario. J Anaesthesiol Clin Pharmacol 2020; 36:316-324. [PMID: 33487897 PMCID: PMC7812941 DOI: 10.4103/joacp.joacp_250_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022] Open
Abstract
Shared Decision Making (SDM) in peri-operative medicine is increasingly encouraged as an ideal model of treatment decision making in the medical encounter. Moreover, it has the potential to improve the quality of the decision-making process for patients and ultimately, patient outcomes. This review focuses on several published literature on SDM in peri-operative medicine, its Implementation, barriers faced by Patient and the Provider, Myths regarding SDM and current scenario of SDM in India. Within the anesthetic community, patient consent is vigorously guided. However, this community suffers from lack of advancements in implementing the patient-focused rather than doctor-focused characteristics of SDM. Out of the several barriers, the most common barrier towards the implementation of SDM is the lack of time from the provider community. Within the anesthesia domain, the consultations discussed directly preceding the surgery do not pursue the customary and highly organized stages of typical outpatient consultations. Under these backgrounds and to be successfully implemented, it becomes imperative to begin the process of SDM pre-operative assessment clinic targeting both the high- and low-risk patients. It is critical to summarise that SDM does not end at the time of anesthesia for the peri-operative healthcare professional, but it gets to carry forward until patient discharge. Therefore, it is carried as the Pinnacle of Patient-Centred Care.
Collapse
Affiliation(s)
- G V Krishna Prasad
- Classified Specialist (Anaesthesiology) Military Hospital Kirkee, Pune, Maharashtra, India
| |
Collapse
|
7
|
Gransjøen AM, Wiig S, Lysdahl KB, Hofmann BM. Health care personnel's perception of guideline implementation for musculoskeletal imaging: a process evaluation. BMC Health Serv Res 2020; 20:397. [PMID: 32393317 PMCID: PMC7212587 DOI: 10.1186/s12913-020-05272-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/29/2020] [Indexed: 01/29/2023] Open
Abstract
Background The increasing complexity and variability in radiology have significantly fueled the need for guidelines. There are many methods for disseminating and implementing guidelines however; and obtaining lasting changes has been difficult. Implementation outcome is usually measured in a decrease in unwarranted examinations, and qualitative data are rarely used. This study’s aim was to evaluate a guideline implementation process and identify factors influencing implementation outcome using qualitative data. Methods Seven general practitioners and five radiological personnel from a Norwegian county participated in four focus group interviews in 2019. The data were analyzed using qualitative content analysis, where some categories were predetermined, while most were drawn from the data. Results Four main categories were developed from the data material. 1) Successful/unsuccessful parts of the implementation, 2) perceived changes/lack of changes after the implementation, 3) environment-related factors that affected guideline use, and 4) User related factors that affect guideline use. Conclusions Our findings show that clinical guideline implementation is difficult, despite the implementation strategy being tailored to the target groups. Several environment- and user-related factors contributed to the lack of changes experienced in practice for both general practitioners and radiological personnel.
Collapse
Affiliation(s)
- Ann Mari Gransjøen
- Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.
| | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 41, 4036, Stavanger, Norway
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, Box 235, 3603, Kongsberg, PO, Norway
| | - Bjørn Morten Hofmann
- Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.,Center for medical ethics, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway
| |
Collapse
|
8
|
Weir A, Kitto S, Smith J, Presseau J, Colman I, Hatcher S. Barriers and enablers to conducting cluster randomized control trials in hospitals: A theory-informed scoping review. EVALUATION AND PROGRAM PLANNING 2020; 80:101815. [PMID: 32146300 DOI: 10.1016/j.evalprogplan.2020.101815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/01/2020] [Accepted: 02/29/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cluster randomized control trials (cRCTs) have unique challenges compared to single site trials with regards to conduct of the trial, and it is important to understand these barriers. The aim of this scoping review was to describe the current literature surrounding the implementation of the cRCTs in hospitals. METHODS The search strategy was designed to identify literature relevant to conduct of cRCTs, with hospitals as the unit of randomization. Data was extracted and was mapped using the Consolidated Framework for Implementation Research (CFIR) as a codebook, which contains 39 constructs organized into five domains. RESULTS Twenty-two articles met inclusion criteria and were included. 18 of 39 constructs of the CFIR were identified in coding, spanning four of the five domains. Barriers to the conduct of the trial were rarely reported as the main outcome of the study, and few details were included in the identified literature. CONCLUSIONS The review can provide guidance to future researchers planning cRCTs in hospitals. It also identified a large gap in reporting of conduct of these trials, demonstrating the need for a research agenda that further explores the barriers and facilitators, with the aim of garnering knowledge for improved guidance in the implementation.
Collapse
Affiliation(s)
- Arielle Weir
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Simon Kitto
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Jennifer Smith
- Population Health, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, K1N 7K4, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, K1H 8L6, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada
| | - Simon Hatcher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, K1H 8L6, Canada
| |
Collapse
|
9
|
Kahlke RM, McConnell MM, Wisener KM, Eva KW. The disconnect between knowing and doing in health professions education and practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:227-240. [PMID: 30904958 DOI: 10.1007/s10459-019-09886-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
Safe and effective healthcare requires that new knowledge or skills, once learned, are incorporated into professional practice. However, this process is not always straightforward. Learning takes place in complex contexts, requiring practitioners to overcome various motivational, systemic, emotional, and social barriers to the application of knowledge. This paper explores the mechanisms through which individuals translate knowledge into action to provide insight into why disconnects between knowledge and action can arise. As a critical review, the aim was to draw on key literature from multiple fields to analyse and synthesize existing schools of thought and lay a strong conceptual foundation on which knowledge to action gaps might be considered. We iteratively consulted clinicians and experts in various fields to guide literature searches focused on theoretical perspectives that could inform educational and research efforts around knowledge-to-action gaps. Key theoretical perspectives on motivation address when and how individuals decide to take action. Literatures from cognitive science address how clinicians and learners self-regulate to (sometimes) overcome barriers to action. Sociocultural theories examine the ways in which action might be prevented by social norms that conflict with what the individual knows and believes, potentially also giving rise to counter-normative action. No single perspective will entirely explain how health professionals and learners implement knowledge in practice. As a result, the authors offer multiple lenses through which to view the problem, and then propose how each of these lenses might better guide educational and research efforts to untangle this challenging but important issue.
Collapse
Affiliation(s)
- Renate M Kahlke
- Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, ON, K1S 5N8, Canada.
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada.
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada.
| | - Meghan M McConnell
- Department of Innovation in Medical Education & Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - Katherine M Wisener
- Faculty Development, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kevin W Eva
- Department of Medicine & Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| |
Collapse
|
10
|
Munro S, Manski R, Donnelly KZ, Agusti D, Stevens G, Banach M, Boardman MB, Brady P, Bradt CC, Foster T, Johnson DJ, Norsigian J, Nothnagle M, Shepherd HL, Stern L, Trevena L, Elwyn G, Thompson R. Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. Implement Sci 2019; 14:95. [PMID: 31706329 PMCID: PMC6842477 DOI: 10.1186/s13012-019-0941-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in primary care and family planning clinics. The two SDM interventions comprised a patient-targeted intervention (video and prompt card) and a provider-targeted intervention (encounter decision aids and training). Methods Participants were clinical and administrative staff aged 18 years or older who worked in one of the 12 clinics in the intervention arm, had email access, and consented to being audio-recorded. Semi-structured telephone interviews were conducted upon completion of the trial. Audio recordings were transcribed verbatim. Data collection and thematic analysis were informed by the 14 domains of the Theoretical Domains Framework, which are relevant to the successful implementation of provider behaviour change interventions. Results Interviews (n = 29) indicated that the interventions were not systematically implemented in the majority of clinics. Participants felt the interventions were aligned with their role and they had confidence in their skills to use the decision aids. However, the novelty of the interventions, especially a need to modify workflows and change behavior to use them with patients, were implementation challenges. The interventions were not deeply embedded in clinic routines and their use was threatened by lack of understanding of their purpose and effect, and staff absence or turnover. Participants from clinics that had an enthusiastic study champion or team-based organizational culture found these social supports had a positive role in implementing the interventions. Conclusions Variation in capabilities and motivation among clinical and administrative staff, coupled with inconsistent use of the interventions in routine workflow contributed to suboptimal implementation of the interventions. Future trials may benefit by using implementation strategies that embed SDM in the organizational culture of clinical settings.
Collapse
Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, E204 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. .,Centre for Health Evaluation and Outcome Sciences, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Ruth Manski
- Society of Family Planning, 225 South 17th Street, Suite 2709, Philadelphia, PA, 19103, USA
| | - Kyla Z Donnelly
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Daniela Agusti
- Dartmouth College Health Service, 7 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Gabrielle Stevens
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | | | - Maureen B Boardman
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | | | | | - Tina Foster
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.,Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Deborah J Johnson
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Judy Norsigian
- Our Bodies Ourselves, P.O. Box 590403, Newton Center, MA, 02459, USA
| | - Melissa Nothnagle
- Department of Family and Community Medicine, University of California San Francisco, Natividad Medical Center, 1441 Constitution Blvd, Salinas, CA, 93906, USA
| | - Heather L Shepherd
- Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia
| | - Lisa Stern
- Planned Parenthood Northern California, 2185 Pacheco St, Concord, CA, 94520, USA
| | - Lyndal Trevena
- Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia
| | - Glyn Elwyn
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Rachel Thompson
- Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia
| |
Collapse
|
11
|
Ben Charif A, Croteau J, Adekpedjou R, Zomahoun HTV, Adisso EL, Légaré F. Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients. Med Decis Making 2019; 39:661-672. [PMID: 31423898 DOI: 10.1177/0272989x19866296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Cluster randomized trials are important sources of information on evidence-based practices in primary care. However, there are few sources of intracluster correlation coefficients (ICCs) for designing such trials. We inventoried ICC estimates for shared decision-making (SDM) measures in primary care. Methods. Data sources were studies led by the Canada Research Chair in Shared Decision Making and Knowledge Transition. Eligible studies were conducted in primary care, included at least 2 hierarchical levels, included SDM measures for individual units nested under any type of cluster (area, clinic, or provider), and were approved by an ethics committee. We classified measures into decision antecedents, decision processes, and decision outcomes. We used Bayesian random-effect models to estimate mode ICCs and the 95% highest probability density interval (HPDI). We summarized estimates by calculating median and interquartile range (IQR). Results. Six of 14 studies were included. There were 97 ICC estimates for 17 measures. ICC estimates ranged from 0 to 0.5 (median, 0.03; IRQ, 0-0.07). They were higher for process measures (median, 0.03; IQR, 0-0.07) than for antecedent measures (0.02; 0-0.07) or outcome measures (0.02; 0-0.06), for which, respectively, "decisional conflict" (mode, 0.48; 95% HPDI, 0.39-0.57), "reluctance to disclose uncertainty to patients" (0.5; 0.11-0.89), and "quality of the decision" (0.45; 0.14-0.84) had the highest ICCs. ICCs for provider-level clustering (median, 0.06; IQR, 0-0.13) were higher than for other levels. Limitations. This convenience sample of studies may not reflect all potential ICC ranges for primary care SDM measures. Conclusions. Our inventory of ICC estimates for SDM measures in primary care will improve the ease and accuracy of power calculations in cluster randomized trials and inspire its further expansion in SDM contexts.
Collapse
Affiliation(s)
- Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Jordie Croteau
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - Evehouenou Lionel Adisso
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| |
Collapse
|
12
|
Shaw J, Rudzicz F, Jamieson T, Goldfarb A. Artificial Intelligence and the Implementation Challenge. J Med Internet Res 2019; 21:e13659. [PMID: 31293245 PMCID: PMC6652121 DOI: 10.2196/13659] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background Applications of artificial intelligence (AI) in health care have garnered much attention in recent years, but the implementation issues posed by AI have not been substantially addressed. Objective In this paper, we have focused on machine learning (ML) as a form of AI and have provided a framework for thinking about use cases of ML in health care. We have structured our discussion of challenges in the implementation of ML in comparison with other technologies using the framework of Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS). Methods After providing an overview of AI technology, we describe use cases of ML as falling into the categories of decision support and automation. We suggest these use cases apply to clinical, operational, and epidemiological tasks and that the primary function of ML in health care in the near term will be decision support. We then outline unique implementation issues posed by ML initiatives in the categories addressed by the NASSS framework, specifically including meaningful decision support, explainability, privacy, consent, algorithmic bias, security, scalability, the role of corporations, and the changing nature of health care work. Results Ultimately, we suggest that the future of ML in health care remains positive but uncertain, as support from patients, the public, and a wide range of health care stakeholders is necessary to enable its meaningful implementation. Conclusions If the implementation science community is to facilitate the adoption of ML in ways that stand to generate widespread benefits, the issues raised in this paper will require substantial attention in the coming years.
Collapse
Affiliation(s)
- James Shaw
- Women's College Hospital, Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Frank Rudzicz
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Trevor Jamieson
- Women's College Hospital, Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada.,St Michael's Hospital, Toronto, ON, Canada
| | - Avi Goldfarb
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
13
|
Daly C, Micic S, Facey M, Speller B, Yee S, Kennedy ED, Corter AL, Baxter NN. A review of factors affecting patient fertility preservation discussions & decision-making from the perspectives of patients and providers. Eur J Cancer Care (Engl) 2018; 28:e12945. [PMID: 30375696 DOI: 10.1111/ecc.12945] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/17/2018] [Accepted: 09/08/2018] [Indexed: 11/30/2022]
Abstract
Women undergoing cancer treatments and their healthcare providers encounter challenges in fertility preservation (FP) discussions and decision-making. A systematic review of qualitative research was conducted to gain in-depth understanding of factors influencing FP discussions and decision-making. Major bibliographic databases and grey literature in English from 1994 to 2016 were searched for qualitative research exploring patient/provider perspectives on barriers and facilitators to FP decision-making. Two researchers screened article titles, abstracts and full-texts. Verbatim data on research questions, study methodology, participants, findings and discussions of findings were extracted. Quality assessment and thematic analysis were conducted. The search yielded 74 studies dating from 2007 onwards; 29 met the inclusion criteria. Analysis revealed three types of barriers: (a) FP knowledge, skills and information deficits contributed to discomfort for providers and discontent for patients; (b) psychosocial factors and clinical issues influenced providers' practices around FP discussions and patients' decision-making; and (c) material, social and structural factors (e.g., lack of resources and accessibility) posed challenges to FP discussions. Potential facilitators to FP discussions and decision-making were also identified. A discussion of ways to improve physician's knowledge and facilitate women's decision-making and access to FP is presented, along with areas for policy development and further research.
Collapse
Affiliation(s)
- Corinne Daly
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Selena Micic
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcia Facey
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Speller
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samantha Yee
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arden L Corter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Treasure T, King A, Hidalgo Lemp L, Golesworthy T, Pepper J, Takkenberg JJM. Developing a shared decision support framework for aortic root surgery in Marfan syndrome. Heart 2018; 104:480-486. [PMID: 28780581 PMCID: PMC5861390 DOI: 10.1136/heartjnl-2017-311598] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The study is an early phase of development of a decision support framework for people with Marfan syndrome who are anticipating prophylactic aortic root surgery. Implications of the timing and the nature of the operation chosen were previously elicited in focus groups. In this step, we explored the range of relative values placed by individuals on the implications of decisions made about surgery. METHODS Following the principles of the Ottawa Decision Support Framework, eight questions in the general form 'How important is it to you …' were framed by a panel. Marfan people, families and specialist doctors answered online. Quantitative and qualitative analyses were performed. RESULTS Worldwide, 142 responses were received including 25 specialist doctors. Respondents were 55% female and 46% had previous aortic root surgery. Overall, active lifestyle was more important to males (p=0.03). Patients placed more importance than doctors on not deferring surgery (p=0.04) and on avoidance of anticoagulation in the interests of childbearing (p=0.009). Qualitative analysis showed differing but cogently reasoned values that were sometimes polarised, and mainly driven by the wish to maintain a good quality of life and active lifestyle. CONCLUSIONS Given the cogency of these viewpoints, people anticipating root replacement surgery should have ample opportunity to express them and to have them acknowledged ahead of a consultation when they can then be fully explored in a mutually informed forum. If they differ from local medical practice, they can then be discussed in the process of reaching shared and individualised decisions.
Collapse
Affiliation(s)
- Tom Treasure
- Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Annette King
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | | | | | - John Pepper
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Johanna JM Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Nies YH, Ali AM, Abdullah N, Islahudin F, Shah NM. A qualitative study among breast cancer patients on chemotherapy: experiences and side-effects. Patient Prefer Adherence 2018; 12:1955-1964. [PMID: 30319245 PMCID: PMC6167974 DOI: 10.2147/ppa.s168638] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of this study was to explore the experiences and side-effects of breast cancer patients on chemotherapy in Malaysia. PARTICIPANTS AND METHODS Purposive sampling of 36 breast cancer patients who have completed chemotherapy and agreed to participate in semi-structured in-depth interviews. A constant comparative method and thematic analysis were used to analyze the interviews. RESULTS Data were categorized into six main themes: know nothing of chemotherapy; fear of chemotherapy; patients' beliefs in alternative treatments; symptom management; staying healthy after chemotherapy; and concerns of patients after chemotherapy. CONCLUSION Despite complaints about the bad experiences of their chemotherapy-induced side-effects, these patients still managed to complete the entire course of chemotherapy. Moreover, there is a need for a clinical pharmacy service in the oncology clinic setting in Malaysia in order to provide relevant information to help patients understand the chemotherapy received.
Collapse
Affiliation(s)
- Yong Hui Nies
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Adliah Mhd Ali
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Norlia Abdullah
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | | |
Collapse
|
16
|
Lam Wai Shun P, Bottari C. Development and Pilot Testing of a Measure of Potential Barriers and Facilitators to the Use of a Standardized Assessment Tool. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:94-101. [PMID: 29624521 DOI: 10.1097/ceh.0000000000000194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Standardized assessment tools (SATs) are essential to evidence-based assessment practices. Identifying what impedes clinicians' use of a SAT can help tailor strategies promoting its use in clinical practice. This article presents the development of the "Measure of potential barriers and facilitators to the Use of a Standardized assessment Tool (MUST)" questionnaire. Preliminary findings are also reported from pilot testing in which the MUST was used to investigate occupational therapists' (OTs) perceptions of potential barriers and facilitators to the use of the Activities of Daily Living Profile (ADL Profile), a SAT evaluating independence in everyday activities of cognitively impaired adults. METHODS The MUST was administered to 41 OTs attending continuing education workshops on the ADL Profile. Internal consistency was explored using Chronbach alpha. Descriptive statistics were used to analyze scores for each statement. RESULTS Internal consistency for subscales related to clinicians' characteristics (α = 0.7) and to the SAT's characteristics (α = 0.8) were adequate but lower for the subscale related to the clinical setting (α = 0.6). OTs' perceptions of potential barriers were associated with: OTs' perceived self-efficacy; ADL Profile's applicability to OTs' clienteles; ADL Profile's compatibility with values promoted in the work setting and with clients' preferences; limited peer support; time to implement the ADL Profile. DISCUSSION The MUST, a theory-informed questionnaire, may prove useful in identifying potential barriers needing to be addressed in continuing education training promoting the use of SATs by clinicians. The MUST is quick to administer and initial testing provides support for its internal consistency.
Collapse
Affiliation(s)
- Priscilla Lam Wai Shun
- Ms. Lam Wai Shun: Doctoral Candidate, Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada. Dr. Bottari: Associate Professor, Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada, and Researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
| | | |
Collapse
|
17
|
Beanlands H, Maione M, Poulton C, Herreshoff E, Hladunewich MA, Hailperin M, Modes MM, An L, Nunes JW, Trachtman H, Nachman P, Gipson DS. Learning to live with nephrotic syndrome: experiences of adult patients and parents of children with nephrotic syndrome. Nephrol Dial Transplant 2017; 32:i98-i105. [PMID: 28391342 DOI: 10.1093/ndt/gfw344] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/20/2016] [Indexed: 01/24/2023] Open
Abstract
Background People living with nephrotic syndrome (NS) need to develop an in-depth understanding of their condition in order to participate in treatment decisions, develop self-management skills and integrate illness into daily life. However, the learning needs of adult patients and parents of children with NS are unknown. We therefore explored patient and parent perspectives on learning needs related to NS as part of a larger study to develop a shared learning tool for NS. Methods Qualitative data were collected using semistructured focus groups and individual interviews with adult patients (n = 22) and parents of children with NS (n = 25). Results The complexity of NS and its treatment made decision making challenging, as patients/parents often had to assimilate information about a condition that is poorly understood. Specific informational needs related to understanding the diagnosis and treatment approaches as well as learning to manage NS were identified. Difficulty in getting accurate information often made learning challenging. The importance of learning to monitor their condition, including understanding triggers that might precipitate a relapse, was highlighted, underscoring the need for individualized approaches to ensure unique learning needs are addressed. Conclusions Our findings reveal some of the unique concerns of people with NS given its uncertain course and the limited information available specific to NS. These results suggest the need for shared communication between the patient/parents and providers to elicit the patient's/parents' understanding of NS and to support them in meeting their unique learning needs.
Collapse
Affiliation(s)
- Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, POD 464B, Toronto, ON, Canada
| | - Maria Maione
- Daphne Cockwell School of Nursing, Ryerson University, POD 464B, Toronto, ON, Canada
| | - Caroline Poulton
- Division of Nephrology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Emily Herreshoff
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Lawrence An
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Julie Wright Nunes
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, New York University, New York, NY, USA
| | - Patrick Nachman
- Division of Nephrology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Debbie S Gipson
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
18
|
Johannessen AK, Tveiten S, Werner A. User participation in a Municipal Acute Ward in Norway: dilemmas in the interface between policy ideals and work conditions. Scand J Caring Sci 2017; 32:815-823. [PMID: 28833351 DOI: 10.1111/scs.12512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 07/05/2017] [Indexed: 12/01/2022]
Abstract
User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.
Collapse
Affiliation(s)
- Anne-Kari Johannessen
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Sidsel Tveiten
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
19
|
Salbach NM, Wood-Dauphinee S, Desrosiers J, Eng JJ, Graham ID, Jaglal SB, Korner-Bitensky N, MacKay-Lyons M, Mayo NE, Richards CL, Teasell RW, Zwarenstein M, Bayley MT. Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial. Implement Sci 2017; 12:100. [PMID: 28764752 PMCID: PMC5539742 DOI: 10.1186/s13012-017-0631-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes. Methods As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis. Results Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates. Conclusions Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers. Trial registration Unique identifier-NCT00359593 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0631-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada. .,Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada.
| | - Sharon Wood-Dauphinee
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue nord, Bureau FM-2208, Sherbrooke, QC, J1H 5N4, Canada
| | - Janice J Eng
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Nicol Korner-Bitensky
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Dalhousie University, Office 405 Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Nancy E Mayo
- Division of Clinical Epidemiology, Division of Geriatrics, McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec (IRDPQ) Site Hamel, 525 Boul. Wilfrid-Hamel Est, Québec, QC, G1M 2S8, Canada
| | - Robert W Teasell
- Parkwood Institute, 550 Wellington Road, London, ON, N6C 0A7, Canada
| | - Merrick Zwarenstein
- Schulich School of Medicine and Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada
| | | |
Collapse
|
20
|
Munce SEP, Graham ID, Salbach NM, Jaglal SB, Richards CL, Eng JJ, Desrosiers J, MacKay-Lyons M, Wood-Dauphinee S, Korner-Bitensky N, Mayo NE, Teasell RW, Zwarenstein M, Mokry J, Black S, Bayley MT. Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial. BMC Health Serv Res 2017. [PMID: 28651530 PMCID: PMC5485614 DOI: 10.1186/s12913-017-2389-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was a cluster randomized controlled trial that evaluated two knowledge translation (KT) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function, postural control, and mobility. Twenty rehabilitation centers across Canada were randomly assigned to either the facilitated or passive KT intervention. The objective of the current study was to understand the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses, occupational therapists and physical therapists, and clinical managers following completion of the trial. Methods A qualitative descriptive approach involving focus groups was used. Thematic analysis was used to understand the factors influencing the implementation of the recommended treatments and KT interventions. The Clinical Practice Guidelines Framework for Improvement guided the analysis. Results Thirty-three participants were interviewed from 11 of the 20 study sites (6 sites from the facilitated KT arm and 5 sites from the passive KT arm). The following factors influencing the implementation of the recommended treatments and KT interventions emerged: facilitation, agreement with the intervention – practical, familiarity with the recommended treatments, and environmental factors, including time and resources. Each of these themes includes the sub-themes of facilitator and/or barrier. Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations. Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial. Conclusions This is one of the first studies to examine the factors influencing the implementation of stroke recommendations and associated KT interventions within the context of a trial. Findings highlight the important role of self-selected facilitators to implementation efforts. Future research should seek to better understand the specific characteristics of facilitators that are associated with successful implementation and clinical outcomes, especially within the context of stroke rehabilitation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2389-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sarah E P Munce
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
| | - Ian D Graham
- Centre for Practice-Changing Research, The Ottawa Hospital Research Institute, 501 Smyth Road, Box 711, Ottawa, Ontario, K1H 8L6, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec City, Quebec, Canada.,Institut de Réadaptation en Déficience Physique de Québec (IRDPQ) Site Hamel, 525 Boul. Wilfrid-Hamel Est, Québec City, Quebec, G1M 2S8, Canada
| | - Janice J Eng
- University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Johanne Desrosiers
- Université de Sherbrooke, Faculty of Medicine and Health Sciences, 3001, 12e avenue nord, Bureau FM-2208, Sherbrooke, Québec, J1H 5N4, Canada
| | - Marilyn MacKay-Lyons
- Office 405 Forrest Building, School of Physiotherapy, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Sharon Wood-Dauphinee
- McGill University, School of Physical and Occupational Therapy, 3630 Promenade Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Nicol Korner-Bitensky
- McGill University, School of Physical and Occupational Therapy, 3630 Promenade Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Nancy E Mayo
- Division of Clinical Epidemiology, Division of Geriatrics, McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada
| | - Robert W Teasell
- Parkwood Institute, 550 Wellington Road, London, Ontario, N6C 0A7, Canada
| | - Merrick Zwarenstein
- Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, Ontario, N6A 3K7, Canada
| | - Jennifer Mokry
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada
| | - Sandra Black
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A4 21, Toronto, Ontario, M4N 3M5, Canada
| | - Mark T Bayley
- Neuro Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada
| |
Collapse
|
21
|
Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies-A systematic review. PLoS One 2017; 12:e0173904. [PMID: 28358864 PMCID: PMC5373562 DOI: 10.1371/journal.pone.0173904] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) is a 9-item measure of the decisional process in medical encounters from both patients' and physicians' perspectives. It has good acceptance, feasibility, and reliability. This systematic review aimed to 1) evaluate the use of the SDM-Q-9 and SDM-Q-Doc in intervention studies on shared decision making (SDM) in clinical settings, 2) describe how the SDM-Q-9 and SDM-Q-Doc performed regarding sensitivity to change, and 3) assess the methodological quality of studies and study protocols that use the measure. METHODS We conducted a systematic review of studies published between 2010 and October 2015 that evaluated interventions to facilitate SDM. The search strategy comprised three databases (EMBASE, PsycINFO, and Medline), reference tracking, citation tracking, and personal knowledge. Two independent reviewers screened titles and abstracts as well as full texts of potentially relevant records. We extracted the data using a pilot tested sheet, and we assessed the methodological quality of included studies using the Quality Assessment Tools from the U.S. National Institute of Health (NIH). RESULTS Five completed studies and six study protocols fulfilled the inclusion criteria. The measure was used in a variety of health care settings, mainly in Europe, to evaluate several types of interventions. The reported mean sum scores ranged from 42 to 75 on a scale from 0 to 100. In four studies no significant change was detected in the mean-differences between main groups. In the fifth study the difference was small. Quality assessment revealed a high risk of bias in four of the five completed studies, while the study protocols received moderate quality ratings. CONCLUSIONS We found a wide range of areas in which the SDM-Q-9 and SDM-Q-Doc were applied. In the future this review may help researchers decide whether the measure fits their purposes. Furthermore, the review revealed risk of bias in previous trials that used the measure, and may help future trials decrease this risk. More research on the measure's sensitivity to change is strongly suggested.
Collapse
|
22
|
Del Río-Lanza AB, Suárez-Álvarez L, Suárez-Vázquez A, Vázquez-Casielles R. Information provision and attentive listening as determinants of patient perceptions of shared decision-making around chronic illnesses. SPRINGERPLUS 2016; 5:1386. [PMID: 27610305 PMCID: PMC4993719 DOI: 10.1186/s40064-016-3086-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 08/16/2016] [Indexed: 01/14/2023]
Abstract
Background While chronic illnesses are a major concern of the health system worldwide, little is known about patients–physicians communication. Growing demand for patient-centered care and shared decision-making have increased the interest for patients–physicians communication. Based on previous literature, we propose a model in which the effect of information provision and attentive listening over patients’ perceptions of shared decision-making (PPSDM) is mediated by the variables self-efficacy and proactivity. Primary data were collected between April and August 2014 through an online survey of patients with haemophilia. Haemophilia is a chronic disease in which many options of treatment are available. The right option depends, to some extent, on patient’s preferences. In this context, great uncertainty exists when choosing treatment option and shared decision-making plays an essential role. Results A total of 181 patients with haemophilia participated in the survey. The psychometric properties of the measurement scales were evaluated by means of a confirmatory factor analysis. A structural equation model was designed. Results show that provision of information and attentive listening determine PPSDM through patients’ self-efficacy and proactivity in requesting information. Conclusions It is important to incorporate communication training in medical education, particularly provision of information and attentive listening. These skills help the healthcare professional to gain a deeper understanding of the patient. Furthermore, provision of information and attentive listening are fundamental in helping patients not to undervalue their personal knowledge and expertise in relation to their doctors. These strategies encourage them to adopt a more active position in requesting information. Encouraging a proactive behaviour of patients and their relatives helps them to realize the need to participate and to make them feel that they are part of the decision-making process.
Collapse
Affiliation(s)
- Ana-Belén Del Río-Lanza
- Biomedicine and Health Cluster, Business Administration Department, School of Economy and Business, University of Oviedo, Avenida del Cristo s/n, 33071 Oviedo, Asturias Spain ; Spanish Federation of Haemophilia, Madrid, Spain
| | - Leticia Suárez-Álvarez
- Biomedicine and Health Cluster, Business Administration Department, School of Economy and Business, University of Oviedo, Avenida del Cristo s/n, 33071 Oviedo, Asturias Spain
| | - Ana Suárez-Vázquez
- Biomedicine and Health Cluster, Business Administration Department, School of Economy and Business, University of Oviedo, Avenida del Cristo s/n, 33071 Oviedo, Asturias Spain
| | - Rodolfo Vázquez-Casielles
- Biomedicine and Health Cluster, Business Administration Department, School of Economy and Business, University of Oviedo, Avenida del Cristo s/n, 33071 Oviedo, Asturias Spain
| |
Collapse
|
23
|
DeMeester RH, Lopez FY, Moore JE, Cook SC, Chin MH. A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients. J Gen Intern Med 2016; 31:651-62. [PMID: 26988980 PMCID: PMC4870417 DOI: 10.1007/s11606-016-3608-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.
Collapse
Affiliation(s)
- Rachel H. DeMeester
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Fanny Y. Lopez
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Jennifer E. Moore
- Institute for Medicaid Innovation, Washington, DC USA
- Department of Obstetrics & Gynecology, Medical School, University of Michigan, Ann Arbor, MI USA
| | - Scott C. Cook
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Marshall H. Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| |
Collapse
|
24
|
Zong JY, Leese J, Klemm A, Sayre EC, Memetovic J, Esdaile JM, Li LC. Rheumatologists’ Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice. Arthritis Care Res (Hoboken) 2015; 67:1463-70. [DOI: 10.1002/acr.22605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Jeff Y. Zong
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Jenny Leese
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Alexandria Klemm
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Eric C. Sayre
- Arthritis Research Canada; Vancouver British Columbia Canada
| | | | - John M. Esdaile
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| |
Collapse
|
25
|
Tomko C, Davis K, Ludin S, Kelly S, Stern A, Luta G, Taylor KL. Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening. Transl Behav Med 2015; 5:189-97. [PMID: 26029281 DOI: 10.1007/s13142-014-0301-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Informed decision-making tools are recommended for men considering prostate cancer screening. We evaluated the extent to which use of an interactive, web-based decision aid was associated with decisional and screening outcomes. Participants (N = 253) were 57 (7.0) years old and completed telephone interviews at baseline, 1 month, and 13 months post-baseline. Tracking software captured minutes spent on the website (median = 33.9), sections viewed (median = 4.0/5.0), testimonials viewed (median = 4.0/6.0), and values clarification tool (VCT) use (77.3 %). In multivariable analyses, all four website use variables were positively associated with increased knowledge (p's < 0.05). Complete VCT use and number of informational sections were positively associated with greater decisional satisfaction (p's < 0.05). Decisional conflict and screening behavior were not associated with measures of website use. Increased use of informational content and interactive elements were related to improved knowledge and satisfaction. Methods to increase utilization of interactive website components may improve informed decision-making outcomes.
Collapse
Affiliation(s)
- Catherine Tomko
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| | - Kimberly Davis
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| | - Samantha Ludin
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| | - Scott Kelly
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| | - Aaron Stern
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| |
Collapse
|
26
|
Coutu MF, Légaré F, Durand MJ, Corbière M, Stacey D, Bainbridge L, Labrecque ME. Operationalizing a shared decision making model for work rehabilitation programs: a consensus process. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:141-152. [PMID: 25001070 DOI: 10.1007/s10926-014-9532-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The objective of this study was to design and operationalize shared decision making (SDM) rehabilitation model for worker rehabilitation programs. SDM has previously been shown to improve decision outcomes in patient-health care professional relationships. To date, SDM has not yet been adapted to work rehabilitation, although it could be a valuable approach to better understand and agree on return-to-work decisions. METHODS We designed a preliminary model for return-to-work decisions for workers suffering from pain due to musculoskeletal injuries. We submitted the preliminary model and a questionnaire to expert health care professionals. Using the Technique for Research of Information by Animation of a Group of Experts method, a group consensus process was used to discuss and refine the experts' responses to operationalize a model adapted for rehabilitation. RESULTS Eleven occupational therapists (three were clinical coordinators) and four psychologists participated in three group consensus sessions. The final version of the model included one general longitudinal objective (the maintenance of a working alliance and assuring mutual comprehension among all stakeholders), and 11 specific objectives: establishing a working alliance, seven in the deliberation phase of the SDM process, and three in the implementation of the decision. Participants also reached consensus on between 1 and 8 indicators per objective. CONCLUSION We developed and operationalized an SDM rehabilitation model intended for a return-to-work implementation plan. The next step will be to document its feasibility among the main stakeholders (employer, union, insurer and worker) taking part in decisions about return to work.
Collapse
Affiliation(s)
- Marie-France Coutu
- Research Center - Hôpital Charles-Le Moyne, Université de Sherbrooke, 150, Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada,
| | | | | | | | | | | | | |
Collapse
|
27
|
Tapp H, McWilliams A, Ludden T, Kuhn L, Taylor Y, Alkhazraji T, Halladay J, Derkowski D, Mohanan S, Dulin M. Comparing traditional and participatory dissemination of a shared decision making intervention (ADAPT-NC): a cluster randomized trial. Implement Sci 2014; 9:158. [PMID: 25359128 PMCID: PMC4219101 DOI: 10.1186/s13012-014-0158-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a common disease that affects people of all ages and has significant morbidity and mortality. Poor outcomes and health disparities related to asthma result in part from the difficulty of disseminating new evidence and care delivery methods such as shared decision making (SDM) into clinical practice. METHODS/DESIGN This non-blinded study will randomize 30 primary care clinics in NC stratified by four PBRNs. We will test dissemination across these practices using a facilitator-led participatory approach to dissemination (FLOW), a novel method of participatory dissemination involving key principles of community-based participatory research, and a more typical "lunch and learn" dissemination method. Specifically, we will use cluster randomization to assign each of the 30 practices to one of three arms: (1) control, no dissemination; (2) traditional dissemination, one didactic session a year and distribution of educational material; and (3) FLOW dissemination. We hypothesize that at the unit of randomization, the clinic, patients in the FLOW dissemination arm will be more likely to share in their treatment decisions compared to patients in the traditional dissemination or control arms. All outcomes will be measured at the level of the clinic. Adoption of the SDM approach will be evaluated by 1) asthma exacerbations, 2) level of patient involvement in the decision making process, and 3) qualitative assessments from patients and providers. TRIAL REGISTRATION The trial was registered on January 27, 2014 through the United States National Institutes of Health's ClinicalTrials.gov NCT02047929 and funded by the Patient-Centered Outcomes Research Institute (PCORI).
Collapse
Affiliation(s)
- Hazel Tapp
- />Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Suite 400 Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Andrew McWilliams
- />Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Suite 400 Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Thomas Ludden
- />Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, USA
| | - Lindsay Kuhn
- />Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Suite 400 Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Yhenneko Taylor
- />Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, USA
| | - Thamara Alkhazraji
- />Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, USA
| | - Jacquie Halladay
- />Department of Family Medicine, UNC Chapel Hill and The Cecil G. Sheps Center for Health Services Research, Chapel Hill, USA
| | | | - Sveta Mohanan
- />Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Suite 400 Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Michael Dulin
- />Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, USA
| |
Collapse
|
28
|
The Herzl Patient Health Information Service: An innovative solution to the problem of informing patients in primary care. JOURNAL OF THE CANADIAN HEALTH LIBRARIES ASSOCIATION 2014. [DOI: 10.5596/c11-034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
29
|
Tapp H, Kuhn L, Alkhazraji T, Steuerwald M, Ludden T, Wilson S, Mowrer L, Mohanan S, Dulin MF. Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices. J Asthma 2014; 51:380-90. [PMID: 24350877 PMCID: PMC4002642 DOI: 10.3109/02770903.2013.876430] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/26/2013] [Accepted: 12/12/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Translating research findings into clinical practice is a major challenge to improve the quality of healthcare delivery. Shared decision making (SDM) has been shown to be effective and has not yet been widely adopted by health providers. This paper describes the participatory approach used to adapt and implement an evidence-based asthma SDM intervention into primary care practices. METHODS A participatory research approach was initiated through partnership development between practice staff and researchers. The collaborative team worked together to adapt and implement a SDM toolkit. Using the RE-AIM framework and qualitative analysis, we evaluated both the implementation of the intervention into clinical practice, and the level of partnership that was established. Analysis included the number of adopting clinics and providers, the patients' perception of the SDM approach, and the number of clinics willing to sustain the intervention delivery after 1 year. RESULTS All six clinics and physician champions implemented the intervention using half-day dedicated asthma clinics while 16% of all providers within the practices have participated in the intervention. Themes from the focus groups included the importance of being part the development process, belief that the intervention would benefit patients, and concerns around sustainability and productivity. One year after initiation, 100% of clinics have sustained the intervention, and 90% of participating patients reported a shared decision experience. CONCLUSIONS Use of a participatory research process was central to the successful implementation of a SDM intervention in multiple practices with diverse patient populations.
Collapse
Affiliation(s)
- Hazel Tapp
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Lindsay Kuhn
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Thamara Alkhazraji
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Mark Steuerwald
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Tom Ludden
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Sandra Wilson
- Department of Health Services Research, Palo Alto Medical Foundation Research InstitutePalo Alto, CAUSA
| | - Lauren Mowrer
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Sveta Mohanan
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| | - Michael F. Dulin
- Department of Family Medicine, Carolinas Healthcare SystemCharlotte, NCUSA
| |
Collapse
|
30
|
Snijders HS, Kunneman M, Bonsing BA, de Vries AC, Tollenaar RAEM, Pieterse AH, Stiggelbout AM. Preoperative risk information and patient involvement in surgical treatment for rectal and sigmoid cancer. Colorectal Dis 2014; 16:O43-9. [PMID: 24188458 DOI: 10.1111/codi.12481] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/10/2013] [Indexed: 02/08/2023]
Abstract
AIM Surgery for rectal and sigmoid cancer is a model setting for investigating preoperative information provision and shared decision making (SDM), as the decision consists of a trade-off between the pros and cons of different treatment options. The aim of this study was to explore surgeons' opinion on the preoperative information that should be given to rectal and sigmoid cancer patients and to evaluate what is actually communicated. In addition, we assessed surgeons' attitudes towards SDM and compared these with patient involvement. METHOD A questionnaire was sent to Dutch surgeons with an interest in gastroenterology. Preoperative consultations were recorded. A checklist was used to code the information that surgeons communicated to the patients. The OPTION-scale was used to measure patient involvement. RESULTS Questionnaires were sent to 240 surgeons, and 103 (43%) responded. They stated that information on anastomotic leakage and its consequences, the benefits and risks of a defunctioning stoma and the impact of a stoma on quality of life were necessary preoperative information. In practice, patients were inconsistently informed of these items. Most participants agreed to using SDM in their consultations. However, in practice, most patients were offered only one treatment option and little SDM was seen. The mean OPTION-score was low (7/100). CONCLUSION Insufficient information is given to patients with rectal and sigmoid cancer to guide them on their preferred surgical option. Information should be given on all treatment options, together with their complications and outcome, before any decision is made.
Collapse
Affiliation(s)
- H S Snijders
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
31
|
Agency and implementation: Understanding the embedding of healthcare innovations in practice. Soc Sci Med 2013; 78:26-33. [DOI: 10.1016/j.socscimed.2012.11.021] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 11/14/2012] [Accepted: 11/19/2012] [Indexed: 11/22/2022]
|
32
|
Pyl N, Menard P. Evaluation of nurses' perceptions on providing patient decision support with cardiopulmonary resuscitation. ISRN NURSING 2012; 2012:591541. [PMID: 23304547 PMCID: PMC3529485 DOI: 10.5402/2012/591541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/05/2012] [Indexed: 11/23/2022]
Abstract
The decision whether to receive cardiopulmonary resuscitation (CPR) is a decision in which the personal values of the patient must be considered along with information about the risks and benefits of the treatment. A decision aid can be used to provide patient decision support to a patient who is seriously ill and needs to consider CPR options. The goal of this project was to identify the barriers and facilitators to using a CPR decision aid, through evaluating nursing perceptions on providing patient decision support. Using a needs assessment, it was determined that implementing a patient decision aid for CPR status in the Acute Monitor Area (AMA) of The Ottawa Hospital would be an excellent quality improvement project. The nurses who chose to participate were given an education session regarding patient decision support. Questionnaires were distributed to evaluate their views of patient decision support and decision aids before and after the education session and implementation of the CPR decision aid. Questionnaire results did not indicate a significant change between before or after education session and decision aid implementation. Qualitative reports did indicate that nurses generally have positive attitudes toward patient decision support and decision aids. The nurses identified specific barriers and facilitators in their commentaries. This clinically relevant data supports the idea that patient decision support should be integrated into daily nursing practice.
Collapse
Affiliation(s)
- Nicole Pyl
- The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
| | - Prudy Menard
- The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
| |
Collapse
|
33
|
Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian Physicians And Patients’ Fear Of Being Labeled ‘Difficult’ Among Key Obstacles To Shared Decision Making. Health Aff (Millwood) 2012; 31:1030-8. [PMID: 22566443 DOI: 10.1377/hlthaff.2011.0576] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dominick L. Frosch
- Dominick L. Frosch ( ) is an associate investigator in the Department of Health Services Research at the Palo Alto Medical Foundation Research Institute, in California, and an associate professor in the Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Suepattra G. May
- Suepattra G. May is an assistant research anthropologist at the Palo Alto Medical Foundation Research Institute
| | - Katharine A.S. Rendle
- Katharine A.S. Rendle is a qualitative research analyst at the Palo Alto Medical Foundation Research Institute
| | - Caroline Tietbohl
- Caroline Tietbohl is a research assistant at the Palo Alto Medical Foundation Research Institute
| | - Glyn Elwyn
- Glyn Elwyn is a primary care physician and researcher, and a visiting professor and senior scientist at the Dartmouth Center for Health Care Delivery Science and the Dartmouth Institute for Health Policy and Clinical Practice, in Hanover, New Hampshire
| |
Collapse
|
34
|
Mathers N, Ng CJ, Campbell MJ, Colwell B, Brown I, Bradley A. Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: a cluster randomised controlled trial (PANDAs) in general practice. BMJ Open 2012; 2:bmjopen-2012-001469. [PMID: 23129571 PMCID: PMC3532975 DOI: 10.1136/bmjopen-2012-001469] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of a patient decision aid (PDA) to improve decision quality and glycaemic control in people with diabetes making treatment choices using a cluster randomised controlled trial (RCT). DESIGN A cluster RCT. SETTING 49 general practices in UK randomised into intervention (n=25) and control (n=24). PARTICIPANTS General practices Inclusion criteria: >4 medical partners; list size >7000; and a diabetes register with >1% of practice population. 191 practices assessed for eligibility, and 49 practices randomised and completed the study. Patients People with type 2 diabetes mellitus (T2DM) taking at least two oral glucose-lowering drugs with maximum tolerated dose with a glycosolated haemoglobin (HbA1c) greater than 7.4% (IFCC HbA1c >57 mmol/mol) or advised in the preceeding 6 months to add or consider changing to insulin therapy. EXCLUSION CRITERIA currently using insulin therapy; difficulty reading or understanding English; difficulty in understanding the purpose of the study; visual or cognitive impairment or mentally ill. A total of 182 assessed for eligibility, 175 randomised to 95 intervention and 80 controls, and 167 completion and anlaysis. INTERVENTION Brief training of clinicians and use of PDA with patients in single consultation. PRIMARY OUTCOMES Decision quality (Decisional Conflict Scores, knowledge, realistic expectations and autonomy) and glycaemic control (glycosolated haemoglobin, HbA1c). SECONDARY OUTCOMES Knowledge and realistic expectations of the risks and benefits of insulin therapy and diabetic complications. RESULTS Intervention group: lower total Decisional Conflict Scores (17.4 vs 25.2, p<0.001); better knowledge (51.6% vs 28.8%, p<0.001); realistic expectations (risk of 'hypo', 'weight gain', 'complications'; 81.0% vs 5.2%, 70.5% vs 5.3%, 26.3% vs 5.0% respectively, p<0.001); and were more autonomous in decision-making (64.1% vs 42.9%, p=0.012). No significant difference in the glycaemic control between the two groups. CONCLUSIONS Use of the PANDAs decision aid reduces decisional conflict, improves knowledge, promotes realistic expectations and autonomy in people with diabetes making treatment choices in general practice. ISRCTN TRIALS REGISTER NUMBER: 14842077.
Collapse
Affiliation(s)
- Nigel Mathers
- Academic Unit of Primary Medical Care, Northern General Hospital, University of Sheffield, Sheffield, UK
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Brigitte Colwell
- Academic Unit of Primary Medical Care, Northern General Hospital, University of Sheffield, Sheffield, UK
| | - Ian Brown
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Alastair Bradley
- Academic Unit of Primary Medical Care, Northern General Hospital, University of Sheffield, Sheffield, UK
| |
Collapse
|
35
|
Holmes-Rovner M, Kelly-Blake K, Dwamena F, Dontje K, Henry RC, Olomu A, Rovner DR, Rothert ML. Shared Decision Making Guidance Reminders in Practice (SDM-GRIP). PATIENT EDUCATION AND COUNSELING 2011; 85:219-224. [PMID: 21282030 DOI: 10.1016/j.pec.2010.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 12/08/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision. METHODS Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit. RESULTS Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. CONCLUSION Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. PRACTICE IMPLICATIONS Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.
Collapse
Affiliation(s)
- Margaret Holmes-Rovner
- Center for Ethics and Humanities in the Life Sciences, C203 East Fee, Michigan State University College of Human Medicine, East Lansing, MI 48824-1316, USA.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med 2011; 9:46. [PMID: 21524315 PMCID: PMC3103434 DOI: 10.1186/1741-7015-9-46] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. METHODS Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. RESULTS Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities. CONCLUSIONS This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.
Collapse
|
37
|
Légaré F, Labrecque M, LeBlanc A, Njoya M, Laurier C, Côté L, Godin G, Thivierge RL, O'Connor A, St-Jacques S. Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. Health Expect 2011; 14 Suppl 1:96-110. [PMID: 20629764 PMCID: PMC3073122 DOI: 10.1111/j.1369-7625.2010.00616.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs). OBJECTIVE To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs. DESIGN Two-arm parallel clustered pilot randomized controlled trial. SETTING AND PARTICIPANTS Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated. INTERVENTION DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs. MAIN OUTCOME MEASURES Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status. RESULTS Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar. DISCUSSION AND CONCLUSIONS DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation.
Collapse
Affiliation(s)
- France Légaré
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, QC, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Straus SE, Tetroe JM, Graham ID. Knowledge translation is the use of knowledge in health care decision making. J Clin Epidemiol 2011; 64:6-10. [PMID: 19926445 DOI: 10.1016/j.jclinepi.2009.08.016] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/25/2009] [Accepted: 08/14/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To provide an overview of the science and practice of knowledge translation. STUDY DESIGN Narrative review outlining what knowledge translation is and a framework for its use. RESULTS Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham et al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories. CONCLUSIONS Review of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions.
Collapse
Affiliation(s)
- Sharon E Straus
- Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Shutter Wing 2-026, Toronto, Ontario M5B1W8, Canada.
| | | | | |
Collapse
|
39
|
Allaire AS, Labrecque M, Giguère A, Gagnon MP, Grimshaw J, Légaré F. Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: a study protocol. Implement Sci 2011; 6:3. [PMID: 21214919 PMCID: PMC3023690 DOI: 10.1186/1748-5908-6-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/07/2011] [Indexed: 11/28/2022] Open
Abstract
Background In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale. Methods/design This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+. Discussion Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared decision making regarding the use of antibiotics in acute respiratory infections, to facilitate its dissemination in primary care on a large scale. Our results should help continuing medical educators develop a continuing medical education program in shared decision making for other clinically relevant topics. This will help optimize clinical decisions in primary care.
Collapse
Affiliation(s)
- Anne-Sophie Allaire
- Research Center of Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer an Health Technology Assessment Research Group, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada.
| | | | | | | | | | | |
Collapse
|
40
|
Curran JA, Grimshaw JM, Hayden JA, Campbell B. Knowledge translation research: the science of moving research into policy and practice. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2011; 31:174-180. [PMID: 21953658 DOI: 10.1002/chp.20124] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Research findings will not change health outcomes unless health care organizations, systems, and professionals adopt them in practice. Knowledge translation research is the scientific study of the methods to promote the uptake of research findings by patients, health care providers, managers, and policy makers. Many forms of enquiry addressing different questions are needed to develop the evidence base for knowledge translation. In this paper we will present a description of the broad scope of knowledge translation research with a reflection on activities needed to further develop the science of knowledge translation. Consideration of some of the shared research challenges facing the fields of knowledge translation and continuing professional development will also be presented.
Collapse
Affiliation(s)
- Janet A Curran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | | | | | | |
Collapse
|
41
|
Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, Frémont P, Gagnon J, Tremblay N, Légaré F. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst 2010; 36:241-77. [PMID: 20703721 DOI: 10.1007/s10916-010-9473-4] [Citation(s) in RCA: 284] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/08/2010] [Indexed: 01/18/2023]
Abstract
This systematic review of mixed methods studies focuses on factors that can facilitate or limit the implementation of information and communication technologies (ICTs) in clinical settings. Systematic searches of relevant bibliographic databases identified studies about interventions promoting ICT adoption by healthcare professionals. Content analysis was performed by two reviewers using a specific grid. One hundred and one (101) studies were included in the review. Perception of the benefits of the innovation (system usefulness) was the most common facilitating factor, followed by ease of use. Issues regarding design, technical concerns, familiarity with ICT, and time were the most frequent limiting factors identified. Our results suggest strategies that could effectively promote the successful adoption of ICT in healthcare professional practices.
Collapse
|
42
|
Harrison MB, Légaré F, Graham ID, Fervers B. Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 2009; 182:E78-84. [PMID: 19969563 DOI: 10.1503/cmaj.081232] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Margaret B Harrison
- School of Nursing, Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario.
| | | | | | | |
Collapse
|
43
|
Abstract
Résumé
Les nombreuses enquêtes portant sur la population de plusieurs pays industrialisés incluant le Canada indiquent que de plus en plus, dans le contexte des rencontres médecin-patient, les patients désirent participer activement aux décisions portant sur leur santé. Toutefois, ces enquêtes rapportent aussi que ce partage de la décision entre les patients et les médecins n’a pas préséance. Le présent texte donne les raisons expliquant l’intérêt de la population et des décideurs envers la prise de décision partagée. Il introduit les fondements conceptuels de la prise de décision partagée et fait état de quelques travaux empiriques dans ce domaine. À l’aide de données recueillies lors d’une étude descriptive des pratiques médicales en matière de dépistage prénatal du syndrome de Down, il discute la relation médecin-patiente lors de ces rencontres. Enfin, il propose quelques pistes de réflexion pour des recherches futures.
Collapse
Affiliation(s)
- France Légaré
- Chaire de recherche du Canada, Implantation de la prise de décision partagée dans les soins Primaires, Département de médecine familiale,Université Laval
| |
Collapse
|
44
|
Affiliation(s)
- Sharon E Straus
- LiKaShing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.
| | | | | |
Collapse
|
45
|
Jones LA, Weymiller AJ, Shah N, Bryant SC, Christianson TJH, Guyatt GH, Gafni A, Smith SA, Montori VM. Should clinicians deliver decision aids? Further exploration of the statin choice randomized trial results. Med Decis Making 2009; 29:468-74. [PMID: 19605885 DOI: 10.1177/0272989x09333120] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Statin Choice is a decision aid about taking statins. The optimal mode of delivering Statin Choice (or any other decision aid) in clinical practice is unknown. METHODS To investigate the effect of mode of delivery on decision aid efficacy, the authors further explored the results of a concealed 2 x 2 factorial clustered randomized trial enrolling 21 endocrinologists and 98 diabetes patients and randomizing them to 1) receive either the decision aid or pamphlet about cholesterol, and 2) have these delivered either during the office visit (by the clinician) or before the visit (by a researcher). We estimated between-group differences and their 95% confidence intervals (CI) for acceptability of information delivery (1-7), knowledge about statins and coronary risk (0-9), and decisional conflict about statin use (0-100) assessed immediately after the visit. Follow-up was 99%. RESULTS The relative efficacy of the decision aid v. pamphlet interacted with the mode of delivery. Compared with the pamphlet, patients whose clinicians delivered the decision aid during the office visit showed significant improvements in knowledge (difference of 1.6 of 9 questions, CI 0.3, 2.8) and nonsignificant trends toward finding the decision aid more acceptable (odds ratio 3.1, CI 0.9, 11.2) and having less decisional conflict (difference of 7 of 100 points, CI -4, 18) than when a researcher delivered the decision aid just before the office visit. CONCLUSIONS Delivery of decision aids by clinicians during the visit improves knowledge and shows a trend toward better acceptability and less decisional conflict.
Collapse
Affiliation(s)
- Lesley A Jones
- Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Comorbidities, Frailty, and “Pay-off Time”. Med Care 2009; 47:607-9. [DOI: 10.1097/mlr.0b013e3181a5c629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Gagnon MP, Lepage-Savary D, Gagnon J, St-Pierre M, Simard C, Rhainds M, Lemieux R, Gauvin FP, Desmartis M, Légaré F. Introducing patient perspective in health technology assessment at the local level. BMC Health Serv Res 2009; 9:54. [PMID: 19327160 PMCID: PMC2671501 DOI: 10.1186/1472-6963-9-54] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/27/2009] [Indexed: 11/17/2022] Open
Abstract
Background Recognizing the importance of increased patient participation in healthcare decisions leads decision makers to consider effective ways to incorporate patient perspectives in Health Technology Assessment (HTA) processes. The implementation of local health HTA units in university hospitals in Quebec provides a unique opportunity to foster an increased participation of patients in decisions regarding health technologies and clinical interventions. This project explores strategies that could be effective in involving patients in HTA activities at the local level. To do so, three objectives are pursued: 1) To synthesise international knowledge and experiences on patient and public involvement in HTA activities; 2) To explore the perceptions of stakeholders (administrators, clinical managers, healthcare professionals, HTA producers, and patients) regarding strategies for involving patients in various HTA activities; and 3) To produce a consensual strategic framework that could guide interventions for involving patients in HTA activities at the local level. Methods A systematic review of the literature will be conducted to synthesise international knowledge and experiments regarding the implication of patients and public in HTA. Then, focus groups will be carried out with representatives of various stakeholder groups in order to explore their perceptions regarding patient participation in HTA. Based on findings from the systematic review and the focus groups, a framework to support patient participation in HTA activities will be proposed. It will then be validated during a deliberative meeting with the research team, composed of scientists and decision makers, and representatives from different groups involved in HTA in Quebec. This deliberative meeting will aim at identifying the type and the degree of participation as well as the adequate timing for involving patients in local HTA activities. Discussion Given the actual state of evidence, integrating patient perspective in HTA activities has the potential to improve the quality of healthcare services. This study provides an opportunity to bridge the gap between HTA producers and its ultimate end-user: the patient. It will provide guidance to support local HTA units in Quebec and elsewhere in their decisions regarding patient participation. The framework developed could be applied to design and implement strategies for involving patients in HTA activities.
Collapse
|
48
|
Elwyn G, Légaré F, Weijden TVD, Edwards A, May C. Arduous implementation: does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice. Implement Sci 2008; 3:57. [PMID: 19117509 PMCID: PMC2631595 DOI: 10.1186/1748-5908-3-57] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 12/31/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice. METHODS The Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources. RESULTS A conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood. CONCLUSION The model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacted.
Collapse
Affiliation(s)
- Glyn Elwyn
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, CF14 4YS, UK
| | - France Légaré
- Department of Family Medicine, Université Laval, Centre Hospitalier Universitaire de Québec, Hôpital St-François d'Assise10 Rue Espinay, Québec, G1L 3L5, Canada
| | - Trudy van der Weijden
- Department of General Practice, School for Primary Care and Public Health (Caphri), Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
| | - Adrian Edwards
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, CF14 4YS, UK
| | - Carl May
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK
| |
Collapse
|
49
|
Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. PATIENT EDUCATION AND COUNSELING 2008; 73:526-35. [PMID: 18752915 DOI: 10.1016/j.pec.2008.07.018] [Citation(s) in RCA: 795] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 06/29/2008] [Accepted: 07/04/2008] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To update a systematic review on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by health professionals. METHODS From March to December 2006, PubMed, Embase, CINHAL, PsycINFO, and Dissertation Abstracts were searched. Studies were included if they reported on health professionals' perceived barriers and facilitators to implementing shared decision-making in practice. Quality of the included studies was assessed. Content analysis was performed with a pre-established taxonomy. RESULTS Out of 1130 titles, 10 new eligible studies were identified for a total of 38 included studies compared to 28 in the previous version. The vast majority of participants (n=3231) were physicians (89%). The three most often reported barriers were: time constraints (22/38) and lack of applicability due to patient characteristics (18/38) and the clinical situation (16/38). The three most often reported facilitators were: provider motivation (23/38) and positive impact on the clinical process (16/38) and patient outcomes (16/38). CONCLUSION This systematic review update confirms the results of the original review. PRACTICE IMPLICATIONS Interventions to foster implementation of shared decision-making in clinical practice will need to address a range of factors.
Collapse
Affiliation(s)
- France Légaré
- Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec, Canada.
| | | | | | | |
Collapse
|
50
|
Desroches S, Gagnon MP, Tapp S, Légaré F. Implementing shared decision-making in nutrition clinical practice: a theory-based approach and feasibility study. Implement Sci 2008; 3:48. [PMID: 18986527 PMCID: PMC2612694 DOI: 10.1186/1748-5908-3-48] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 11/05/2008] [Indexed: 01/08/2023] Open
Abstract
Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior. Methods Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval. Discussion The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views regarding the implementation of shared decision making in different clinical settings. It is anticipated that the results generated by the proposed research project will significantly contribute to the emergence of shared decision making in nutrition through a theory-based approach.
Collapse
Affiliation(s)
- Sophie Desroches
- Centre de recherche du Centre Hospitalier Universitaire de Québec (CHUQ), Hôpital St-François d'Assise, 45, rue Leclerc, Québec, G1L 3L5, Canada.
| | | | | | | |
Collapse
|