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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

Proposed two-phase sequential explanatory study design. In the first phase, quantitative (QUAN) data are collected via web questionnaires and analyzed to inform second phase. In the second phase, qualitative (QUAL) data are collected via interviews and analyzed. Both types of data are then interpreted together.
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Figure 2: Proposed two-phase sequential explanatory study design. In the first phase, quantitative (QUAN) data are collected via web questionnaires and analyzed to inform second phase. In the second phase, qualitative (QUAL) data are collected via interviews and analyzed. Both types of data are then interpreted together.

Mentions: We will use a two-phase mixed methods study with an explanatory sequential design[17], characterized by the collection and analysis of quantitative data in the first phase of research, followed by the collection and analysis of qualitative data in the second phase that builds on and explains the initial results of the quantitative component (Figure2)[17]. In the first phase, a previously validated questionnaire[4] will be used to assess barriers and facilitators relative to the Decision Boxes as innovation. In the second phase, due to a lack of validated questionnaires, a qualitative study will be conducted to explain the barriers and facilitators relative to the environmental context. Quantitative and qualitative study findings will be interpreted together to adapt the Decision Boxes and the strategy to facilitate their use in clinical practice.


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)

Proposed two-phase sequential explanatory study design. In the first phase, quantitative (QUAN) data are collected via web questionnaires and analyzed to inform second phase. In the second phase, qualitative (QUAL) data are collected via interviews and analyzed. Both types of data are then interpreted together.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Proposed two-phase sequential explanatory study design. In the first phase, quantitative (QUAN) data are collected via web questionnaires and analyzed to inform second phase. In the second phase, qualitative (QUAL) data are collected via interviews and analyzed. Both types of data are then interpreted together.
Mentions: We will use a two-phase mixed methods study with an explanatory sequential design[17], characterized by the collection and analysis of quantitative data in the first phase of research, followed by the collection and analysis of qualitative data in the second phase that builds on and explains the initial results of the quantitative component (Figure2)[17]. In the first phase, a previously validated questionnaire[4] will be used to assess barriers and facilitators relative to the Decision Boxes as innovation. In the second phase, due to a lack of validated questionnaires, a qualitative study will be conducted to explain the barriers and facilitators relative to the environmental context. Quantitative and qualitative study findings will be interpreted together to adapt the Decision Boxes and the strategy to facilitate their use in clinical practice.

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