25 research outputs found
Developing and user-testing Decision boxes to facilitate shared decision making in primary care - a study protocol
<p>Abstract</p> <p>Background</p> <p>Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users.</p> <p>Methods/Design</p> <p>We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable), and will include new themes suggested by the data (inductive analysis). Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings.</p> <p>Discussion</p> <p>This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It is the first step in the development and implementation of a new tool that should facilitate decision making in clinical practice.</p
Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study
Background: Decision boxes (Dboxes) provide clinicians with research evidence about management options for
medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare
clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators
to using the Dbox information in clinical practice.
Methods: We used a mixed methods study with sequential explanatory design. We recruited family physicians,
residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions
by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive
impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their
patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following
the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators
to explore contextual factors influencing the use of the Dbox information.
Results: One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they
reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they
would use this information for their patients. Of those who would use the information for their patients, 89%
expected it would benefit their patients, especially in that it would allow the patient to make a decision more in
keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in
practice (mean 5.6 ± 1.2, scale 1â7, with 7 being âhighâ), and their intention was significantly related to social
norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians
mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate
the use of the Dbox information. Some participants would have liked a clear âbottom lineâ statement for each Dbox and
access to printed Dboxes in consultation rooms.
Conclusions: Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in
practic
Perceived barriers to completing an e-learning program on evidence-based medicine
Purpose The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program.
Methods Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs.
Results A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers.
Conclusions This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation
Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician.</p> <p>Methods/design</p> <p>The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline) including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700). The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1) physicians and patients' decisional conflict; 2) the agreement between the parties' decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration.</p> <p>Discussion</p> <p>DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="NCT01116076">NCT01116076</a></p