Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System

Kevin D. Li, Christopher S. Saigal, Megha D. Tandel, Lorna Kwan, Moira Inkelas, Dana L. Alden, Stanley K. Frencher, Kiran Gollapudi, Jeremy Blumberg, Jamal Nabhani and Jonathan Bergman
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Kevin D. Li: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Christopher S. Saigal: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Megha D. Tandel: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Lorna Kwan: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Moira Inkelas: University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
Dana L. Alden: University of Hawai’i at Manoa Shidler College of Business, Marketing, Honolulu, HI, USA
Stanley K. Frencher: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Kiran Gollapudi: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Jeremy Blumberg: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
Jamal Nabhani: Los Angeles County Department of Health Services, Los Angeles, CA, USA
Jonathan Bergman: Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA

Medical Decision Making, 2021, vol. 41, issue 2, 120-132

Abstract: Background Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. Methods We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. Results Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients’ records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. Conclusions Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.

Keywords: decision aids; electronic decision aids; implementation; prostate cancer; shared decision making; vulnerable populations (search for similar items in EconPapers)
Date: 2021
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:41:y:2021:i:2:p:120-132

DOI: 10.1177/0272989X20982533

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