Are Patient Decision Aids Used in Clinical Practice after Rigorous Evaluation? A Survey of Trial Authors

Dawn Stacey, Victoria Suwalska, Laura Boland, Krystina B. Lewis, Justin Presseau and Richard Thomson
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Dawn Stacey: Ottawa Hospital Research Institute, Ottawa, ON, Canada
Victoria Suwalska: Ottawa Hospital Research Institute, Ottawa, ON, Canada
Laura Boland: Ottawa Hospital Research Institute, Ottawa, ON, Canada
Krystina B. Lewis: Ottawa Hospital Research Institute, Ottawa , ON, Canada
Justin Presseau: Ottawa Hospital Research Institute, Ottawa, ON, Canada
Richard Thomson: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK

Medical Decision Making, 2019, vol. 39, issue 7, 805-815

Abstract: Background. Patient decision aids (PtDAs) are effective interventions to support patient involvement in health care decisions, but there is little use in practice. Our study aimed to determine subsequent PtDA use in clinical practice following published randomized controlled trials. Design. A descriptive study using an e-mail-embedded questionnaire survey targeting authors of 133 trials included in Cochrane Reviews of PtDAs (106 authors). We classified PtDA level of use as a) implementation, defined as integrating within care processes; b) dissemination to target users with planned strategies; and c) diffusion, defined as passive, unplanned spread. We conducted content analysis to identify barriers and enablers guided by the Ottawa Model of Research Use. Results. Ninety-eight authors responded (92.5%) on 108 trialed PtDAs. Reported levels of use were implementation ( n = 29; 28%), dissemination to target user(s) ( n = 9; 9%), and diffusion ( n = 7; 7%); 57 (55%) reported no uptake, and 1 had no response (1%). Barriers to use in clinical practice were identified at the level of researchers (e.g., lack of posttrial plan), PtDAs (e.g., outdated, delivery mechanism), clinicians (e.g., disagreed with PtDA use), and practice environment (e.g., infrastructure support; funding). Enablers were online delivery, organizational endorsement (e.g., professional organization, charity, government), and design for and integration into the care process. Limitations. Self-report bias and potential for recall bias. Conclusions. Only 44% of PtDA trial authors indicated some level of subsequent use following their trial. The most commonly reported barriers were lack of funding, outdated PtDAs, and clinician disagreement with PtDA use. To improve subsequent use, researchers should codesign PtDAs with end users to ensure fit with clinical practice and develop an implementation plan. National systems (e.g., platforms, endorsement, funding) can enable use.

Keywords: dissemination; health care; implementation science; patient decision aid (search for similar items in EconPapers)
Date: 2019
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:39:y:2019:i:7:p:805-815

DOI: 10.1177/0272989X19868193

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