What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration

Natalie Joseph-Williams, Purva Abhyankar, Laura Boland, Paulina Bravo, Alison T. Brenner, Suzanne Brodney, Angela Coulter, Anik Giguère, Aubri Hoffman, Mirjam Körner, Aisha Langford, France Légaré, Daniel Matlock, Nora Moumjid, Sarah Munro, Karina Dahl Steffensen, Christine Stirling and Trudy van der Weijden
Additional contact information
Natalie Joseph-Williams: School of Medicine, Cardiff University, Cardiff, UK
Purva Abhyankar: Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
Laura Boland: The Ottawa Hospital Research Institute, School of Health Sciences, Ottawa, Canada and Western University, School of Health Studies, London, ON, Canada
Paulina Bravo: School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
Alison T. Brenner: Division of General Medicine and Clinical Epidemiology, University of North Carolina Medical School, Chapel Hill, NC, USA, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
Suzanne Brodney: Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
Angela Coulter: Coulter & Coulter Ltd, Oxford, UK
Anik Giguère: Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
Aubri Hoffman: Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, USA
Mirjam Körner: Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs University, Freiburg, Germany
Aisha Langford: Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
France Légaré: Department of Family Medicine and Emergency Medicine, Université of Laval, Quebec, Canada
Daniel Matlock: Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
Nora Moumjid: Claude Bernard Lyon 1 University, Léon Bérard Cancer Centre, Lyon, Rhone-Alpes, France
Sarah Munro: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
Karina Dahl Steffensen: Center for Shared Decision Making, Region of Southern Denmark and Department of Clinical Oncology, Vejle/Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark and Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Christine Stirling: School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
Trudy van der Weijden: CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands

Medical Decision Making, 2021, vol. 41, issue 7, 907-937

Abstract: Background Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting. Aim This review was conducted in response to the IPDAS Collaboration’s evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings. Methods Rapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research. Results We developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve. Conclusions We recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.

Keywords: implementation; patient decision aids; rapid realist review; realist methods; shared decision making (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X20978208 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:41:y:2021:i:7:p:907-937

DOI: 10.1177/0272989X20978208

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().