Theory-based approach to developing an implementation plan to support the adoption of a patient decision aid for Down syndrome prenatal screening

Abstract

Background Our team has developed a decision aid to help pregnant women and their partners make informed decisions about Down syndrome prenatal screening. However, the decision aid is not yet widely available in Quebec’s prenatal care pathways. Objective We sought to identify knowledge translation strategies and develop an implementation plan to promote the use of the decision aid in prenatal care services in Quebec, Canada. Methods Guided by the Knowledge-to-Action Framework and the Theoretical Domains Framework, we performed a synthesis of our research (11 publications) on prenatal screening in Quebec and on the decision aid. Two authors independently reviewed the 11 articles, extracted information, and mapped it onto the Knowledge-to-Action framework. Using participatory action research methods, we then recruited pregnant women, health professionals, managers of three prenatal care services, and researchers to (a) identify the different clinical pathways followed by pregnant women and (b) select knowledge translation strategies for a clinical implementation plan. Then, based on all the information gathered, the authors established a consensus on strategies to include in the plan. Results Our knowledge synthesis showed that pregnant women and their partners are not sufficiently involved in the decision-making process about prenatal screening and that there are numerous barriers and facilitators of the use of the decision aid in clinical practice (e.g., low intention to use it among health providers). Using a participatory action approach, we met with five pregnant women, three managers, and six health professionals. They informed us about three of Quebec’s prenatal care pathways and helped us identify 20 knowledge translation strategies (e.g., nurse discusses decision aid with women before they meet the doctor) to include in a clinical implementation plan. The research team reached a consensus about the clinical plan and also about broader organizational strategies, such as training healthcare providers in the use of the decision aid, monitoring its impact (e.g., measure decisional conflict) and sustaining its use (e.g., engage key stakeholders in the implementation process). Conclusion Next steps are to pilot our implementation plan while further identifying global strategies that target institutional, policy, and systemic supports for implementation.

The Evaluation of Web-Based Communication Interventions to Support Decisions About COVID-19 Vaccination Among Patients With Underlying Medical Conditions: Protocol for a Randomized Controlled Trial

“…This tool could be potentially distributed on the web before and during the implementation of vaccination programs. As implementation planning is an important part of the process of implementing evidence-based practices [39], this study will enable public health authorities to use these tools as means of support for patients.…”

Evaluation of the implementation of patient decision aid: A mixed-method study

“…Currently, in PDA literature, studies on effectiveness of PDAs are abundant whereby the outcomes are related to measuring what a PDA is supposed to achieve such as patient outcomes (i.e., decision con ict, decision quality, decision regret) or practice outcomes (i.e., uptake of treatment) [11,12]. There is a lack of focus on implementation aspects of PDA such as evaluation of implementation outcomes.…”

“…Similarly, another study which aimed to embed a PDA for treatment of children with juvenile idiopathic arthritis in routine settings did not achieve their goal of having at least 65% use of the PDA as part of medication discussions between patients and clinicians [6]. A myriad of barriers have been found to contribute to poor uptake of PDAs and many of them are related to implementation barriers such as di culty in integrating PDA into existing patient care pathways, or HCPs' work ow [7], competing quality improvement initiatives in the healthcare setting [8], lack of teamwork [9], and organizational policies and regulation [10].Currently, in PDA literature, studies on effectiveness of PDAs are abundant whereby the outcomes are related to measuring what a PDA is supposed to achieve such as patient outcomes (i.e., decision con ict, decision quality, decision regret) or practice outcomes (i.e., uptake of treatment) [11,12]. There is a lack of focus on implementation aspects of PDA such as evaluation of implementation outcomes.…”