Clinicians' perceptions of digital vs. paper‐based decision support interventions

Politi, Mary C.; Adsul, Prajakta; Kuzemchak, Marie D.; Zeuner, Rachel; Frosch, Dominick L.

doi:10.1111/jep.12269

Cited by 29 publications

(23 citation statements)

References 19 publications

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“…Our ndings align with Politi et al's study that examined clinicians' use of tools where there is no "one-size-ts-all" approach to implementing conversation aids, with variation in patient preferences in format and clinicians' opinions about conversation aids. [53] Our results coincide with another study on a different surgical conversation aid that most patients mentioned the best place to use the conversation aids was during the surgical consultation. [54] However, as also seen in Bunzli's study, patients mentioned that receiving the conversation aid beforehand would be helpful in some circumstances provided the patient already knew their diagnosis.…”

Section: Results In Contextsupporting

confidence: 89%

Implementation and Sustainability Factors of Two Early-Stage Breast Cancer Conversation Aids in Diverse Practices

Schubbe

Yen

Saunders

et al. 2020

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BackgroundConversation aids can facilitate shared decision making and improve patient-centered outcomes. However, there are few examples of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored strategies that will promote the sustained use of two early-stage breast cancer conversation aids. We examined any differences in experiences and opinions between the two conversation aids and across socioeconomic strata. MethodsWe nested this study within a randomized controlled trial evaluating two early-stage breast cancer surgery treatment conversation aids, one text-based and one picture-based, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a sample of patient participants, purposively sampled across conversation aid assignment and socioeconomic status (SES), and collected observations and field-notes. We also interviewed trial surgeons and other stakeholders. We conducted a framework analysis of all interviews, notes, and observations with two independent coders using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on which conversation aid was used/received and patient SES. ResultsWe conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids was similar to their usual care after using it a few times, and most patients felt it appeared part of their normal routine. ConclusionsKey factors that will help guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics and communication preferences.Trial registrationNCT03136367 at ClinicalTrials.gov

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Section: Results In Contextsupporting

confidence: 89%

Implementation and Sustainability Factors of Two Early-Stage Breast Cancer Conversation Aids in Diverse Practices

Schubbe

Yen

Saunders

et al. 2020

Preprint

Self Cite

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show abstract

“…Underserved patients may prefer and benefit more from shorter paper-based interventions used in the clinical encounter (also called encounter decision aids), compared with more complex, digital interventions, which require higher levels of literacy and numeracy, and are more difficult to embed in clinic visits. 26 There is evidence to confirm that encounter decision aids create meaningful conversations about essential trade-offs between available options and increase patient knowledge and patient participation in decision-making with a variable effect on choice and adherence to treatment. 27–30 It has also been hypothesised that encounter decision aids may overcome current barriers to decision aid implementation.…”

Section: Introductionmentioning

confidence: 99%

‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

et al. 2016

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ObjectiveWomen of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer.DesignCommunity-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3).SettingUnderserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics.ParticipantsIn phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer.InterventionThe pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org).Outcome measuresWe assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews.ResultsAfter initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3.Conclusions and relevanceUsing CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast cancer found the Picture Option Grid usable, acceptable and accessible.

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“…The format of the decision aids was adapted from that used in Option Grid decision aids for clinical encounters, which have been found to increase shared decision-making in osteoarthritis care 14 and to be acceptable to physicians. 15 We engaged patients and stakeholders in developing the decision aids, including via a survey of patients and contraceptive care providers, 16 patient focus groups and review of decision aid iterations by patient partners and stakeholder representatives. We developed versions of the decisions aids in English and Spanish.…”

Section: Methodsmentioning

confidence: 99%

Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods

et al. 2017

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IntroductionDespite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods.Methods and analysisWe will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt card and decision aids+training and (4) usual care. The clusters will be clinics in USA that deliver contraceptive care. The participants will be people who have completed a healthcare visit at a participating clinic, were assigned female sex at birth, are aged 15–49 years, are able to read and write English or Spanish and have not previously participated in the study. The primary outcome will be shared decision-making about contraceptive methods. Secondary outcomes will be the occurrence of a conversation about contraception in the healthcare visit, satisfaction with the conversation about contraception, intended contraceptive method(s), intention to use a highly effective method, values concordance of the intended method(s), decision regret, contraceptive method(s) used, use of a highly effective method, use of the intended method(s), adherence, satisfaction with the method(s) used, unintended pregnancy and unwelcome pregnancy. We will collect study data via longitudinal patient surveys administered immediately after the healthcare visit, four weeks later and six months later.Ethics and disseminationWe will disseminate results via presentations at scientific and professional conferences, papers published in peer-reviewed, open-access journals and scientific and lay reports. We will also make an anonymised copy of the final participant-level dataset available to others for research purposes.Trial registration numberClinicalTrials.gov Identifier: NCT02759939.

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Clinicians' perceptions of digital vs. paper‐based decision support interventions

Cited by 29 publications

References 19 publications

Implementation and Sustainability Factors of Two Early-Stage Breast Cancer Conversation Aids in Diverse Practices

Implementation and Sustainability Factors of Two Early-Stage Breast Cancer Conversation Aids in Diverse Practices

‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods

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