Rheumatologists’ Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice

Abstract

Objective. To explore rheumatologists' perceptions of patient decision aids (PtDAs) and identify barriers to using them in clinical practice. Methods. A cross-sectional online survey of all members of the Canadian Rheumatology Association (CRA; n 5 459) was conducted. We subsequently invited 10 respondents to participate in a 30-minute telephone interview to further explore their views on using PtDAs in clinical practice. Interview participants were purposefully sampled to achieve a balance in sex, years in clinical practice, and types of practice. Results. In August and September 2013, 153 CRA members responded to the survey (response rate 33.3%); of those, 113 completed the entire questionnaire. Sixty-three respondents (55.8%) were male, 54 (47.8%) were ‡50 years of age, and 55 (48.7%) practiced in a multidisciplinary setting. When asked about their intention to use PtDAs, participants rated mean 6 SD 5.7 6 2.9 (where 0 5 not likely and 10 5 very likely). Sixty-four (56.6%) believed that rheumatologists were unfamiliar with PtDAs, and 76 (67.3%) thought that PtDAs would disturb their workflow. In-depth interviews revealed the following: the perception that PtDAs were no different from any other patient education tools, the concern that PtDAs were of limited value in real life since they relied solely on data from randomized controlled trials, and the fear that PtDAs could impair doctor-patient communication.Conclusion. There was a sense of ambivalence among rheumatologists about PtDAs. Our interviews further revealed concerns regarding the utility and benefits of PtDAs in clinical practice. The results show a need to familiarize physicians with PtDAs and to develop strategies to support their integration in clinical practice.

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“…The gap between the strong evidence for PtDAs and their poor uptake in clinical practice requires additional investigation to identify strategies to increase PtDA use. Potential barriers to use of PtDAs in practice have been previously identified by Zong et al (7) and include time and workflow disruption and physician lack of familiarity with available PtDAs and their role in the decision‐making process. Understanding what drives current behavior can help inform what interventions will be helpful to change a behavior, such as uptake of PtDAs.…”

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