Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff

Abstract

Background: There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in primary care and family planning clinics. The two SDM interventions comprised a patient-targeted intervention (video and prompt card) and a provider-targeted intervention (encounter decision aids and training). Methods: Participants were clinical and administrative staff aged 18 years or older who worked in one of the 12 clinics in the intervention arm, had email access, and consented to being audio-recorded. Semi-structured telephone interviews were conducted upon completion of the trial. Audio recordings were transcribed verbatim. Data collection and thematic analysis were informed by the 14 domains of the Theoretical Domains Framework, which are relevant to the successful implementation of provider behaviour change interventions. Results: Interviews (n = 29) indicated that the interventions were not systematically implemented in the majority of clinics. Participants felt the interventions were aligned with their role and they had confidence in their skills to use the decision aids. However, the novelty of the interventions, especially a need to modify workflows and change behavior to use them with patients, were implementation challenges. The interventions were not deeply embedded in clinic routines and their use was threatened by lack of understanding of their purpose and effect, and staff absence or turnover. Participants from clinics that had an enthusiastic study champion or team-based organizational culture found these social supports had a positive role in implementing the interventions.

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

“…[52] Surgeons who were able to integrate the conversation aid in their daily clinical practice commented that the conversation aid was very similar to their usual consultation content, also seen in a similar study on contraceptive counseling. [17] Some patients, surgeons, and stakeholders were interested in integrating the conversation aids in the EHR. However, the sample was divided with emphasis on the importance of paper-based conversation aids.…”

Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

“…[52] Surgeons who were able to integrate the conversation aid in their clinical practice mentioned the conversation aid was similar to their usual consultation content, also seen in a similar study on contraceptive counseling. [17] Some patients, surgeons, and stakeholders were interested in integrating the conversation aids in the EHR. However, the sample was divided with emphasis on the importance of paper-based conversation aids.…”

“…[14,16] Buy-in at the clinic level, led by clinical champions, can reinforce the sustainability of an implemented conversation aid. [17] Despite the multiple barriers that exist, tailoring to the individual needs of clinics can ensure better sustainability of an implemented conversation aid. [18] System-level barriers can include a lack of prioritizing implementation efforts and incentivization for clinicians and clinic staff.…”

Scaling-up Shared Decision Making in Multidisciplinary Osteoarthritis Care Teams: A Qualitative Study Using the Consolidated Framework for Implementation Research With Three Demonstration Sites

“…They have highlighted the importance of embedding SDM within the clinical work ow, importance of staff understanding the purpose and effect of SDM strategies, the need for clinical champions, a team-based organisational culture and positive social and implementation supports. [10,11] An analysis of SDM in aged care also highlighted capacity and organisational readiness as important. [12] However, very few studies have used a theoretical foundation to drive the process of implementing SDM in clinical practice, [13] despite theory being important for overcoming implementation barriers and providing structure for evaluation.…”