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What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration

Author

Listed:
  • Natalie Joseph-Williams

    (School of Medicine, Cardiff University, Cardiff, UK)

  • Purva Abhyankar

    (Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK)

  • Laura Boland

    (The Ottawa Hospital Research Institute, School of Health Sciences, Ottawa, Canada and Western University, School of Health Studies, London, ON, Canada)

  • Paulina Bravo

    (School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile)

  • Alison T. Brenner

    (Division of General Medicine and Clinical Epidemiology, University of North Carolina Medical School, Chapel Hill, NC, USA, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA)

  • Suzanne Brodney

    (Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA)

  • Angela Coulter

    (Coulter & Coulter Ltd, Oxford, UK)

  • Anik Giguère

    (Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada)

  • Aubri Hoffman

    (Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, USA)

  • Mirjam Körner

    (Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs University, Freiburg, Germany)

  • Aisha Langford

    (Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA)

  • France Légaré

    (Department of Family Medicine and Emergency Medicine, Université of Laval, Quebec, Canada)

  • Daniel Matlock

    (Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA)

  • Nora Moumjid

    (Claude Bernard Lyon 1 University, Léon Bérard Cancer Centre, Lyon, Rhone-Alpes, France)

  • Sarah Munro

    (Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada)

  • Karina Dahl Steffensen

    (Center for Shared Decision Making, Region of Southern Denmark and Department of Clinical Oncology, Vejle/Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark and Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark)

  • Christine Stirling

    (School of Nursing, University of Tasmania, Hobart, Tasmania, Australia)

  • Trudy van der Weijden

    (CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands)

Abstract

Background Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting. Aim This review was conducted in response to the IPDAS Collaboration’s evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings. Methods Rapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research. Results We developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve. Conclusions We recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.

Suggested Citation

  • Natalie Joseph-Williams & Purva Abhyankar & Laura Boland & Paulina Bravo & Alison T. Brenner & Suzanne Brodney & Angela Coulter & Anik Giguère & Aubri Hoffman & Mirjam Körner & Aisha Langford & Fran, 2021. "What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration," Medical Decision Making, , vol. 41(7), pages 907-937, October.
    • Handle: RePEc:sae:medema:v:41:y:2021:i:7:p:907-937
    DOI: 10.1177/0272989X20978208
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    References listed on IDEAS

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    1. Clarissa Hsu & David T. Liss & Emily O. Westbrook & David Arterburn, 2013. "Incorporating Patient Decision Aids into Standard Clinical Practice in an Integrated Delivery System," Medical Decision Making, , vol. 33(1), pages 85-97, January.
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    Cited by:

    1. Dawn Stacey & Robert J. Volk, 2021. "The International Patient Decision Aid Standards (IPDAS) Collaboration: Evidence Update 2.0," Medical Decision Making, , vol. 41(7), pages 729-733, October.

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