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Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol.

Giguere A, Labrecque M, Grad R, Cauchon M, Greenway M, Légaré F, Pluye P, Turcotte S, Dolovich L, Haynes RB - BMC Med Inform Decis Mak (2012)

Bottom Line: Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions.Web-log data will be used to monitor clinicians' access to the website.Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada. anikgiguere@videotron.ca

ABSTRACT

Background: Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.

Methods/design: A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians' intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians' access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.

Conclusions: This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.

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Related in: MedlinePlus

Conceptual framework for the study of the implementation of Decision Boxes in primary healthcare teams (PHT), including factors explored and methods used. Adapted from Graham and Logan[10].
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Figure 1: Conceptual framework for the study of the implementation of Decision Boxes in primary healthcare teams (PHT), including factors explored and methods used. Adapted from Graham and Logan[10].

Mentions: The proposed project is based on the theory of mechanisms of planned change as described in the Ottawa Model of Research Use (OMRU)[10,11] (Figure1).Derived from evidence and theories of change, the OMRU recognizes that practice change is not a linear process, but involves simultaneous and interactive relationships between the nature of the innovation, the potential adopters, and the context within the practice environment. Three key processes involved are: 1) assessing barriers and supports; 2) developing and monitoring interventions tailored to barriers and supports; 3) evaluating outcomes. The underlying mechanism is that tailoring intervention strategies to address barriers and strengthen facilitators related to the innovation (here Decision Box), potential adopters (here PHT) and practice environment (here primary care clinics) will result in practice change. Barriers and supports related to the innovation will be assessed with the Information Assessment Method[12], those relative to potential adopters using Ajzen's Theory of Planned Behavior (TPB) (attitude, subjective norms, perceived behavioral control)[13] and the Inter-Professional Shared Decision-Making (IP-SDM) model[14,15], and those relative to the primary care practice environment using the IP-SDM model[16]. We will use the identified barriers to tailor the Decision Box intervention before testing it in a future RCT.


Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol.

Giguere A, Labrecque M, Grad R, Cauchon M, Greenway M, Légaré F, Pluye P, Turcotte S, Dolovich L, Haynes RB - BMC Med Inform Decis Mak (2012)

Conceptual framework for the study of the implementation of Decision Boxes in primary healthcare teams (PHT), including factors explored and methods used. Adapted from Graham and Logan[10].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472191&req=5

Figure 1: Conceptual framework for the study of the implementation of Decision Boxes in primary healthcare teams (PHT), including factors explored and methods used. Adapted from Graham and Logan[10].
Mentions: The proposed project is based on the theory of mechanisms of planned change as described in the Ottawa Model of Research Use (OMRU)[10,11] (Figure1).Derived from evidence and theories of change, the OMRU recognizes that practice change is not a linear process, but involves simultaneous and interactive relationships between the nature of the innovation, the potential adopters, and the context within the practice environment. Three key processes involved are: 1) assessing barriers and supports; 2) developing and monitoring interventions tailored to barriers and supports; 3) evaluating outcomes. The underlying mechanism is that tailoring intervention strategies to address barriers and strengthen facilitators related to the innovation (here Decision Box), potential adopters (here PHT) and practice environment (here primary care clinics) will result in practice change. Barriers and supports related to the innovation will be assessed with the Information Assessment Method[12], those relative to potential adopters using Ajzen's Theory of Planned Behavior (TPB) (attitude, subjective norms, perceived behavioral control)[13] and the Inter-Professional Shared Decision-Making (IP-SDM) model[14,15], and those relative to the primary care practice environment using the IP-SDM model[16]. We will use the identified barriers to tailor the Decision Box intervention before testing it in a future RCT.

Bottom Line: Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions.Web-log data will be used to monitor clinicians' access to the website.Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada. anikgiguere@videotron.ca

ABSTRACT

Background: Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.

Methods/design: A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians' intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians' access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.

Conclusions: This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.

Show MeSH
Related in: MedlinePlus