Understanding and overcoming the barriers of implementing patient decision aids in clinical practice.

Patient decision aids (ptDAs) have been developed to assist patients with difficult health-related decisions. Despite their proven effects on decision quality in numerous efficacy trials, we lack an evidence-based approach for implementing them as part of the process of care. Pragmatic trials of ptDAs have uncovered a myriad of implementation challenges; therefore we need a better understanding of the barriers and strategies to overcome them to facilitate their widespread uptake. The following paper provides an overview of the barriers related to the uptake of ptDAs within the process of care and the strategies, opportunities and research priorities to overcome them. This report is based on our interpretation of the literature and our collective experience in implementing ptDAs within trials and other contexts.

[1]  R. McKendry,et al.  Challenges in family practice related to informed and shared decision-making: a survey of preceptors of medical students. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[2]  Mark J Sculpher,et al.  Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial. , 2002, JAMA.

[3]  R. Deyo Tell it like it is , 2000 .

[4]  Margaret Holmes-Rovner,et al.  Implementing shared decision‐making in routine practice: barriers and opportunities , 2000, Health expectations : an international journal of public participation in health care and health policy.

[5]  Developing an OSCE station to assess the ability of medical students to share information and decisions with patients: issues relating to interrater reliability and the use of simulated patients. , 2002, Education for health.

[6]  Glyn Elwyn,et al.  Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors' attitudes and confidence during a randomized trial. , 2004, Journal of evaluation in clinical practice.

[7]  A Laupacis,et al.  A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial. , 1999, JAMA.

[8]  A. Laupacis,et al.  Development of a decision aid for patients with atrial fibrillation who are considering antithrombotic therapy , 2000, Journal of General Internal Medicine.

[9]  E. Rutgers,et al.  Interpretive Review : Feasibility and Effects of Decision Aids , 2000, Medical decision making : an international journal of the Society for Medical Decision Making.

[10]  G. FitzGerald Coxibs and cardiovascular disease. , 2004, The New England journal of medicine.

[11]  Peter Tugwell,et al.  Development and pilot testing of a decision aid for postmenopausal women with osteoporosis. , 2002, Patient education and counseling.

[12]  Glyn Elwyn,et al.  Manufactured but not imported: new directions for research in shared decision making support and skills. , 2003, Patient education and counseling.

[13]  M. Egger,et al.  Risk of cardiovascular events and rofecoxib: cumulative meta-analysis , 2004, The Lancet.

[14]  G. Elwyn,et al.  Towards a feasible model for shared decision making: focus group study with general practice registrars , 1999, BMJ.

[15]  I D Graham,et al.  Decision aids for patients considering options affecting cancer outcomes: evidence of efficacy and policy implications. , 1999, Journal of the National Cancer Institute. Monographs.

[16]  W Godolphin,et al.  Framework for teaching and learning informed shared decision making. , 1999, BMJ.

[17]  I. Graham,et al.  Toward a Comprehensive Interdisciplinary Model of Health Care Research Use , 1998 .

[18]  J. Reginster,et al.  Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. , 2001, The New England journal of medicine.

[19]  Charles Kooperberg,et al.  Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. , 2002, JAMA.

[20]  C Estabrooks,et al.  Decision aids: are they worth it? A systematic review , 2001, Journal of health services research & policy.

[21]  P Tugwell,et al.  A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. , 1998, Patient education and counseling.

[22]  Peter Tugwell,et al.  A qualitative study of physicians' perceptions of three decision aids. , 2003, Patient education and counseling.

[23]  Glyn Elwyn,et al.  The development of COMRADE--a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations. , 2003, Patient education and counseling.

[24]  Alicia O'Cathain,et al.  Evaluating decision aids – where next? , 2004, Health expectations : an international journal of public participation in health care and health policy.

[25]  Robert Riddell,et al.  Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. , 2005, The New England journal of medicine.

[26]  Ann Barry Flood,et al.  Modifying unwarranted variations in health care: shared decision making using patient decision aids. , 2004, Health affairs.

[27]  I. Graham,et al.  Innovations in knowledge transfer and continuity of care. , 2004, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[28]  A. O’Cathain,et al.  Use of evidence based leaflets to promote informed choice in maternity care: randomised controlled trial in everyday practice , 2002, BMJ : British Medical Journal.