Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

Abstract

BackgroundDecision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.Methods/designA two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.ConclusionsThis project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.

Feasibility of a randomized controlled trial to evaluate the impact of decision boxes on shared decision-making processes

“…This feasibility study was an add-on to a larger study on the barriers and facilitators to the implementation of the DBoxes in primary healthcare clinics in Canada, reported elsewhere [ 7 , 10 ]. It included a single experimental group of participants from several clinics who were exposed to the intervention.…”

“…In order for the intervention to be deemed acceptable, we determined a priori and arbitrarily that at least 80% of clinicians’ ratings should demonstrate a level of satisfaction towards the intervention of 4 or 5 out of 5. For feasibility, we set as criteria that: (i) we should recruit at least five primary healthcare clinics [ 10 ]; (ii) clinicians’ recruitment rate should reach at least 50%; (iii) at least 70% of the participating clinicians should complete half of the eight web-questionnaires, or more [ 10 ]; and (iv) four patients should be recruited per clinic per day – a recruitment rate observed in a previous study conducted in similar settings [ 19 ] – during one week, in order to reach an overall sample size of 100 patients.…”

“…We engaged in a series of studies to develop preliminary DBox templates and prototypes [ 8 ], to adapt and standardise the content and format of the DBoxes to users’ needs and preferences [ 8 , 9 ], and to study the barriers to using the educational information from DBoxes in practice, and tailor them to the identified barriers [ 10 , 11 ]. The next step was thus to evaluate the feasibility of conducting a clustered randomized controlled trial (RCT).…”

Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study

“…As described elsewhere [ 35 ], this project was based on the theory of mechanisms of planned change as described in the Ottawa Model of Research Use (OMRU) [ 36 , 37 ]. Quantitative and qualitative sequential phases of data collection and analysis framed this mixed methods study (sequential explanatory design) [ 38 ].…”

“…When receiving a Dbox, the participants completed a three-part web-based questionnaire (available in [ 35 ]). In part I, a 5-point rating scale assessed overall satisfaction.…”