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 1–7, with 7 being “high”), 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 “bottom line” 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