Clinicians' perspectives on the implementation of patient decision aids in the emergency department: A qualitative interview study

Abstract

Objective Decision aids (DAs) are tools to facilitate and standardize shared decision making (SDM). Although most emergency clinicians (ECs) perceive SDM appropriate for emergency care, there is limited uptake of DAs in clinical practice. The objective of this study was to explore barriers and facilitators identified by ECs regarding the implementation of DAs in the emergency department (ED). Methods We conducted a qualitative interview study guided by implementation science frameworks. ECs participated in interviews focused on the implementation of DAs for the disposition of patients with low‐risk chest pain and unexplained syncope in the ED. Interviews were recorded and transcribed verbatim. We then iteratively developed a codebook with directed qualitative content analysis. Results We approached 25 ECs working in urban New York, of whom 20 agreed to be interviewed (mean age, 41 years; 25% women). The following 6 main barriers were identified: (1) poor DA accessibility, (2) concern for increased medicolegal risk, (3) lack of perceived need for a DA, (4) patient factors including lack of capacity and limited health literacy, (5) skepticism about validity of DAs, and (6) lack of time to use DAs. The 6 main facilitators identified were (1) positive attitudes toward SDM, (2) patient access to follow‐up care, (3) potential for improved patient satisfaction, (4) potential for improved risk communication, (5) strategic integration of DAs into the clinical workflow, and (6) institutional support of DAs. Conclusions ECs identified multiple barriers and facilitators to the implementation of DAs into clinical practice. These findings could guide implementation efforts targeting the uptake of DA use in the ED.

Physicians’ perspectives on using a patient decision aid in female stress urinary incontinence

“…Participants think that SDM will be supported by use of a PDA and that patients are better informed and more empowered to participate in the SDM process. The positive effect on SDM and patient empowerment has been shown before in other studies [ 14 , 18 , 19 ].…”

“…Only 43% of the physicians in our study would still use it if consultation time were to increase. Several other studies mention expected prolongation of consultation time as a physicians’ barrier [ 14 , 18 , 20 , 21 ]. The Cochrane review by Stacey et al showed that the median increase in consultation time is 2.6 min when using a PDA during a consultation [ 14 ].…”

Partizipative Entscheidungsfindung in der Notfallmedizin

“…PatientInnen beschreiben darin ein Bedürfnis, über ihre Behandlungsoptionen wissen zu wollen und von den Behandelnden gehört zu werden [25]. Die Behandelnden andererseits sehen verbunden mit der partizipativen Entscheidungsfindung sowohl großes Potenzial als auch bestehende Barrieren in der Implementierung [3].…”