IMPLEMENTING DECISION BOXES IN PRIMARY HEALTHCARE TEAMS TO FACILITATE SHARED DECISION MAKING: BARRIERS AND FACILITATORS

Purpose: Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed, value-based decisions. Our main objective was to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the practice environment (Figure).

Methods : Eight Decision Boxes relevant to primary care were hosted on a website together with a tutorial and education on patient counselling. The Decision Boxes were delivered weekly as email to the clinicians of the PHT (family physicians, residents and nurses). Using a web-questionnaire, clinicians rated each Decision Box with respect to their clinical relevance, cognitive impact, and the intention to use what they learned from that Decision Box in practice. Web-log data was used to monitor clinicians' access to the website. Following the 8-week intervention, semi-structured group interviews with clinicians and individual interviews with clinic administrators were conducted to explore contextual factors influencing the use of the Decision Boxes. Patients who discussed one of the interventions addressed by a Decision Box during their visit completed a survey on shared decision-making processes and on their decisional conflict.

Results: Sixty-four physicians, 11 nurses and 30 residents from five primary healthcare clinics in Quebec, Montreal and Hamilton registered to receive the documents. Twenty-seven percent of the clinicians registered accessed the tutorial and 40% the educational pages. Preliminary data on the three first Decision Boxes delivered indicate a 47% response rate on the web-questionnaires. For these Decision Boxes, clinicians' intention to use what they learned to precisely explain to their patient the advantages and disadvantages of the options averaged 5.9 ± 0.9 (SD) on a scale from 1 (strongly disagree) to 7 (strongly agree), indicating that they had the intention to use what they learned. Clinician interviews and patient questionnaires had yet to be analysed at time of abstract submission.

Conclusions: Preliminary data suggest that the proposed Decision Box approach is valued by PHT. With acceptable questionnaire response rates, this project will allow tailoring of Decision Boxes and their delivery to the specific barriers identified by PHTs to improve the adoption of shared decision making.

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