Primary health care professionals’ views on barriers and facilitators to the implementation of the Ottawa Decision Support Framework in practice

O’Connor, Annette M.; Graham, Ian D.; Saucier, Danielle; Côté, Luc; Blais, Johanne; Cauchon, Michel; Paré, Line

doi:10.1016/j.pec.2006.04.011

Cited by 72 publications

(54 citation statements)

References 46 publications

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“…In a study targeting the identification of barriers to and facilitators of implementing shared decision-making in clinical practice, each type of barrier was provided with a specific definition. 28 The intention was to standardize the reporting of barriers to and facilitators of use of knowledge in the context of health care. 28 Barriers were defined as factors that would limit or restrict implementation of shared decision-making in clinical practice.…”

Section: Acknowledge Source Documentsmentioning

confidence: 99%

“…29 More importantly, the Clinical Practice Guidelines Framework for Improvement was transferred into a list of potential facilitators of use of knowledge in clinical practice. 28 Facilitators were defined as factors that would promote or help implement shared decision-making in clinical practice.Sometimes we forget that the same factor may sometimes be identified both as a barrier to and as a facilitator of use of knowledge, showing the importance of developing a more comprehensive and integrated understanding of both barriers and facilitators concurrently. 30,31 The Clinical Practice Guidelines Framework for Improvement was further extended to include the attributes of innovation as proposed by the Diffusion of Innovation theory.…”

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confidence: 99%

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Adapting clinical practice guidelines to local context and assessing barriers to their use

Harrison¹,

Légaré²,

Graham³

et al. 2009

Canadian Medical Association Journal

308

322

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Key points• Clinical practice guidelines can be adapted to local circumstances and settings to avoid duplication of efforts and optimize use of resources.• The ADAPTE process is an approach to adapting guidelines to local contexts through the explicit participation of relevant decision-makers.• Assessing barriers to and facilitators of the use of knowledge is closely linked to the adaptation and uptake of the evidence. Review CMAJ • FEBRUARY 9, 2010 • 182(2) E79evidence-based practice guidelines have become mandatory for the care of patients with cancer in France. 14 For many regions and territorial jurisdictions, de novo development of guidelines is not feasible because of lack of time, expertise and resources, and thus taking advantage of existing highquality guidelines is sensible. [15][16][17] Adaptation of existing high-quality guidelines for local use is an approach with the potential to reduce duplication of effort and enhance applicability. National guidelines often lack details on applicability and description of the changes in the organization of care required to apply the recommendations. 18 Adaptation of evidence may promote local uptake of evidence through a sense of ownership by the end-users who are engaged in this process. However, customizing a guideline to local conditions could weaken the integrity of the evidence base. We outline a systematic, participatory approach for evaluating and adapting available guidelines to a local context of use while maintaining the quality and validity of the guideline. Whether evidence is provided in the format of syntheses of knowledge, patient decision aids or clinical practice guidelines, end-users must consider if or how it could be adapted to the local context and the same principles can be applied to ensure these factors are considered before implementation of the evidence.To illustrate how to adapt guidelines, we will use a recent study that was performed to improve community care of individuals living with venous ulcers of the leg. 10,13 Regional managers of home care were concerned about costs of supplies, amount of nursing time, and frequency of visiting for clients with ulcers of the leg. A regional task force was developed to review existing practice guidelines to help guide the care plan. The task force identified that many of these guidelines were from international bodies and would require adaptation to the local context. How are guidelines adapted for local use?Existing guidelines can be evaluated and customized to fit local circumstances through an active, systematic and participatory process. This process must preserve the integrity of the evidence-based recommendations when differences in organizational, regional or cultural circumstances may legitimately require important variations in recommendations. 8,9,[14][15][16]19 In adapting a guideline, consideration is given to local evidence, such as specific health questions relevant to a local context of use; to specific needs, priorities, legislation, policies and resources; to scopes of practic...

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Section: Acknowledge Source Documentsmentioning

confidence: 99%

mentioning

confidence: 99%

Adapting clinical practice guidelines to local context and assessing barriers to their use

Harrison¹,

Légaré²,

Graham³

et al. 2009

Canadian Medical Association Journal

308

322

View full text Add to dashboard Cite

show abstract

“…25,50,59,62,89,90 Leadership and staff commitment can remove such barriers to SDM. Staffing diversity and relationships with the community can help organizations coordinate SDM and build attitudes and a culture that support SDM.…”

Section: Driver 3: Organizational Structure and Culturementioning

confidence: 99%

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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“…The Herzl Patient Health Information Service was intended to address known difficulties of informing patients in primary care, namely time, tools, and training [1][2][3]. The addition of a health information professional (HIP) to the healthcare team reduced the burden of informing patients for health professionals (HP), facilitated access to resources, and provided instructional support.…”

Section: Introductionmentioning

confidence: 99%

“…A proliferation of online health information makes it difficult for patients and families to navigate to the most reliable and up-to-date information. Low literacy and health literacy 1 as well as lack of the internet can be barriers to accessing information [7,[16][17][18]. Language and culture are further confounding factors [7,[19][20][21].…”

Section: Introductionmentioning

confidence: 99%

The Herzl Patient Health Information Service: An innovative solution to the problem of informing patients in primary care

Frati¹

2014

J Can Health Libr Assoc

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Primary health care professionals’ views on barriers and facilitators to the implementation of the Ottawa Decision Support Framework in practice

Cited by 72 publications

References 46 publications

Adapting clinical practice guidelines to local context and assessing barriers to their use

Adapting clinical practice guidelines to local context and assessing barriers to their use

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

The Herzl Patient Health Information Service: An innovative solution to the problem of informing patients in primary care

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