Natalie Joseph-Williams1, Purva Abhyankar2, Laura Boland3, Paulina Bravo4, Alison T Brenner5, Suzanne Brodney6, Angela Coulter7, Anik Giguere8, Aubri Hoffman9, Mirjam Körner10, Aisha Langford11, France Légaré12, Daniel Matlock13, Nora Moumjid14, Sarah Munro15, Karina Dahl Steffensen16, Christine Stirling17, Trudy van der Weijden18. 1. School of Medicine, Cardiff University, Cardiff, UK. 2. Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK. 3. The Ottawa Hospital Research Institute, School of Health Sciences, Ottawa, Canada and Western University, School of Health Studies, London, ON, Canada. 4. School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile. 5. 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. 6. Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA. 7. Coulter & Coulter Ltd, Oxford, UK. 8. Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada. 9. Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, USA. 10. Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs University, Freiburg, Germany. 11. Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA. 12. Department of Family Medicine and Emergency Medicine, Université of Laval, Quebec, Canada. 13. Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA. 14. Claude Bernard Lyon 1 University, Léon Bérard Cancer Centre, Lyon, Rhone-Alpes, France. 15. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. 16. 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. 17. School of Nursing, University of Tasmania, Hobart, Tasmania, Australia. 18. CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands.
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.
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.
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Authors: Nick Bansback; Judy A Chiu; Rebecca Metcalfe; Emmanuelle Lapointe; Alice Schabas; Marilyn Lenzen; Anthony Traboulsee; Larry D Lynd; Robert Carruthers Journal: Mult Scler J Exp Transl Clin Date: 2021-07-15