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Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System

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Listed:
  • Kevin D. Li

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
    University of California San Francisco, School of Medicine, San Francisco, CA, USA)

  • Christopher S. Saigal

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA)

  • Megha D. Tandel

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA)

  • Lorna Kwan

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA)

  • Moira Inkelas

    (University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA)

  • Dana L. Alden

    (University of Hawai’i at Manoa Shidler College of Business, Marketing, Honolulu, HI, USA)

  • Stanley K. Frencher

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
    Los Angeles County Department of Health Services, Los Angeles, CA, USA)

  • Kiran Gollapudi

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
    Los Angeles County Department of Health Services, Los Angeles, CA, USA)

  • Jeremy Blumberg

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
    Los Angeles County Department of Health Services, Los Angeles, CA, USA)

  • Jamal Nabhani

    (Los Angeles County Department of Health Services, Los Angeles, CA, USA
    USC Keck School of Medicine, Department of Urology, Los Angeles, CA, USA)

  • Jonathan Bergman

    (Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
    Los Angeles County Department of Health Services, Los Angeles, CA, USA
    VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA)

Abstract

Background Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. Methods We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. Results Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients’ records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. Conclusions Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.

Suggested Citation

  • Kevin D. Li & Christopher S. Saigal & Megha D. Tandel & Lorna Kwan & Moira Inkelas & Dana L. Alden & Stanley K. Frencher & Kiran Gollapudi & Jeremy Blumberg & Jamal Nabhani & Jonathan Bergman, 2021. "Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System," Medical Decision Making, , vol. 41(2), pages 120-132, February.
    • Handle: RePEc:sae:medema:v:41:y:2021:i:2:p:120-132
    DOI: 10.1177/0272989X20982533
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Alden, Dana L. & Friend, John & Fraenkel, Liana & Jibaja-Weiss, Maria, 2018. "The effects of culturally targeted patient decision aids on medical consultation preparation for Hispanic women in the U.S.: Results from four randomized experiments," Social Science & Medicine, Elsevier, vol. 212(C), pages 17-25.
    3. Marie-Anne Durand & Lewis Carpenter & Hayley Dolan & Paulina Bravo & Mala Mann & Frances Bunn & Glyn Elwyn, 2014. "Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-13, April.
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