Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation

Stacey, Dawn; Taljaard, Monica; Smylie, Jennifer; Boland, Laura; Breau, Rodney H.; Carley, Meg; Jana, Kunal; Peckford, Larry; Blackmore, Terry; Waldie, Marian; Wu, Robert

doi:10.1186/s13012-016-0451-1

Cited by 15 publications

(16 citation statements)

References 43 publications

(48 reference statements)

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“…Supervisors were trained in decision support, a trainer workshop was held for supervisory staff members, and the director of the cancer helpline addressed workshop participants to validate that decision support is an important part of their call center role. P29 Stacey et al (2015) [ 106 ] Canada Prospective pragmatic observational trial Cystic fibrosis clinics Adults with cystic fibrosis considering referral for lung transplant Decision aids and other form of decision support Implementation strategy was based on results of prior barriers survey. It consisted of training (workshop and online tutorial), easy access to decision aids, and conference calls for ongoing support.…”

Section: Resultsmentioning

confidence: 99%

Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

et al. 2018

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BackgroundShared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. No reviews have solely focused on an in-depth synthesis of the literature around organizational- and system-level characteristics (i.e., characteristics of healthcare organizations and of healthcare systems) that may affect SDM implementation. A synthesis would allow exploration of interventions to address these characteristics. The study aim was to compile a comprehensive overview of organizational- and system-level characteristics that are likely to influence the implementation of SDM, and to describe strategies to address those characteristics described in the literature.MethodsWe conducted a scoping review using the Arksey and O’Malley framework. The search strategy included an electronic search and a secondary search including gray literature. We included publications reporting on projects that promoted implementation of SDM or other decision support interventions in routine healthcare. We screened titles and abstracts, and assessed full texts for eligibility. We used qualitative thematic analysis to identify organizational- and system-level characteristics.ResultsAfter screening 7745 records and assessing 354 full texts for eligibility, 48 publications on 32 distinct implementation projects were included. Most projects (N = 22) were conducted in the USA. Several organizational-level characteristics were described as influencing the implementation of SDM, including organizational leadership, culture, resources, and priorities, as well as teams and workflows. Described system-level characteristics included policies, clinical guidelines, incentives, culture, education, and licensing. We identified potential strategies to influence the described characteristics, e.g., examples how to facilitate distribution of decision aids in a healthcare institution.ConclusionsAlthough infrequently studied, organizational- and system-level characteristics appear to play a role in the failure to implement SDM in routine care. A wide range of characteristics described as supporting and inhibiting implementation were identified. Future studies should assess the impact of these characteristics on SDM implementation more thoroughly, quantify likely interactions, and assess how characteristics might operate across types of systems and areas of healthcare. Organizations that wish to support the adoption of SDM should carefully consider the role of organizational- and system-level characteristics. Implementation and organizational theory could provide useful guidance for how to address facilitators and barriers to change.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0731-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

et al. 2018

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“…In addition, efforts to improve patients’ education and inform them of expected outcomes with each treatment option could also alleviate stress associated with treatment decisions and improve the quality of care delivered to patients. Researchers are engaged in creating patient decision aids to support decision making under patient's involvement …”

Section: Discussionmentioning

confidence: 99%

National trends in management of localized prostate cancer: A population based analysis 2004‐2013

et al. 2018

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Management of localized prostate cancer changed substantially over time in the United States. Utilization of expectant management has increased for men with low- and intermediate risk cancer. Among those who pursue curative therapy, younger men remain more likely to elect surgery whereas older men tend to choose radiotherapy. Further studies are needed to better characterize factors contributing to treatment selection.

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“…Some designs may be more suited to answer particular research questions within each phase. For example, a comparative case study design is appropriate to identify a potentially effective implementation strategy to test in future research ( 51 ), while a cluster randomized stepped wedge design may be more appropriate when testing the effectiveness and sustainability of an implementation strategy ( 52 ). We could not code for this within our sample, as it is not always specified which phase researchers consider their research questions, but it is possible this is a factor in deciding which design to use.…”

Section: Discussionmentioning

confidence: 99%

Variation in Research Designs Used to Test the Effectiveness of Dissemination and Implementation Strategies: A Review

Mazzucca

Tabak

Pilar

et al. 2018

Front. Public Health

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BackgroundThe need for optimal study designs in dissemination and implementation (D&I) research is increasingly recognized. Despite the wide range of study designs available for D&I research, we lack understanding of the types of designs and methodologies that are routinely used in the field. This review assesses the designs and methodologies in recently proposed D&I studies and provides resources to guide design decisions.MethodsWe reviewed 404 study protocols published in the journal Implementation Science from 2/2006 to 9/2017. Eligible studies tested the efficacy or effectiveness of D&I strategies (i.e., not effectiveness of the underlying clinical or public health intervention); had a comparison by group and/or time; and used ≥1 quantitative measure. Several design elements were extracted: design category (e.g., randomized); design type [e.g., cluster randomized controlled trial (RCT)]; data type (e.g., quantitative); D&I theoretical framework; levels of treatment assignment, intervention, and measurement; and country in which the research was conducted. Each protocol was double-coded, and discrepancies were resolved through discussion.ResultsOf the 404 protocols reviewed, 212 (52%) studies tested one or more implementation strategy across 208 manuscripts, therefore meeting inclusion criteria. Of the included studies, 77% utilized randomized designs, primarily cluster RCTs. The use of alternative designs (e.g., stepped wedge) increased over time. Fewer studies were quasi-experimental (17%) or observational (6%). Many study design categories (e.g., controlled pre–post, matched pair cluster design) were represented by only one or two studies. Most articles proposed quantitative and qualitative methods (61%), with the remaining 39% proposing only quantitative. Half of protocols (52%) reported using a theoretical framework to guide the study. The four most frequently reported frameworks were Consolidated Framework for Implementing Research and RE-AIM (n = 16 each), followed by Promoting Action on Research Implementation in Health Services and Theoretical Domains Framework (n = 12 each).ConclusionWhile several novel designs for D&I research have been proposed (e.g., stepped wedge, adaptive designs), the majority of the studies in our sample employed RCT designs. Alternative study designs are increasing in use but may be underutilized for a variety of reasons, including preference of funders or lack of awareness of these designs. Promisingly, the prevalent use of quantitative and qualitative methods together reflects methodological innovation in newer D&I research.

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Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation

Cited by 15 publications

References 43 publications

Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

National trends in management of localized prostate cancer: A population based analysis 2004‐2013

Variation in Research Designs Used to Test the Effectiveness of Dissemination and Implementation Strategies: A Review

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