Evaluating clinical implementation approaches for prostate cancer decision support

Abstract

PurposeShared decision making is widely promoted for counseling men with localized prostate cancer. Results of randomized trials suggest decision aid efficacy. However, few practices or institutions have implemented decision support as standard practice. The purpose of this study was to evaluate various implementation strategies for the decision aid, Personal Patient Profile-Prostate, and analyze feedback from clinical site staff and providers. Materials and MethodsA hybrid type-1 effectiveness-implementation trial was conducted. Primary data were collected in six urology clinics of three geographically-distinct health networks. During the implementation phase, site-specific strategies were co-designed with site leaders. Referral and access metrics for men with localized prostate cancer were monitored for up to 7 months. Clinical staff reports of barriers and facilitators of implementation were evaluated in professionally-facilitated focus groups. ResultsOf 495 men with localized prostate cancer seen in the clinics, 252 (51%; 95% CI 46-55%) were informed of the program, and 107 of those (43%; 95% CI 36-49%) accessed it. The highest access rates were observed with patient care coordinator email and telephone contact (82%) or verbal physician instruction followed by email and phone invitations (87%). During focus groups, physicians appraised the summaries as useful. Staff-identified barriers included creating new workflows within heavy workloads, and staff misunderstanding of context and resources. Promoters to successful implementation included an identified clinical lead and physician engagement. ConclusionsImplementation success was realized when physicians engaged and staff provided follow-up contacts. New practice changes to implement interventions require multi-modal strategies for early success.