Abstract
BackgroundDecision 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.MethodsWe 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.ResultsOne 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.ConclusionsDboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0144-6) contains supplementary material, which is available to authorized users.
Highlights
Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer
Satisfaction with the decision box Clinicians reported a level of satisfaction with the Dboxes of 4 or 5 on a 5-point smiley-face rating scale ranging from 1 to 5 in 81% of questionnaires completed (373/463)
The value of decision boxes for practice Based on Information Assessment Method (IAM) ratings, reading Dboxes was felt to improve clinical practice (54% of completed questionnaires), in the areas of counselling and disease prevention or health education (Table 3)
Summary
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. Shared decision-making (SDM) structures the sharing of power between clinicians and patients by proposing joint decisions based on an understanding of the benefits and harms of all health-care options and patients’ preferences in regard to those options [3]. Patient decision aids (PtDAs) are among the strategies most often used to effectively facilitate SDM [4,5]. These tools provide patients with information on the options and research-based outcomes relevant to their health status and help clarify values regarding the benefits and harms of each option [6]. In most of these studies, clinicians were either unexposed to any intervention [11,12,13,14,15,16], received a financial incentive for time spent prescribing PtDAs [17] or viewing the PtDAs [18], or were exposed to a limited intervention such as brief training on how to use PtDAs [19]
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