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Open Access Study protocol

Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

Anik Giguere1*, Michel Labrecque2, Roland Grad3, Michel Cauchon4, Matthew Greenway5, France Légaré6, Pierre Pluye7, Stephane Turcotte8, Lisa Dolovich9 and R Brian Haynes10

Author Affiliations

1 Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada

2 Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada

3 Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal (QC), H2W 1 S4, Canada

4 Dept. of Family and Emergency Medicine, Laval University Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, Local 4617, Québec (QC), G1V 0A6, Canada

5 Department of Family Medicine, McMaster University, 118 Lake Street, Saint-Catharines, ON, Canada

6 Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada

7 Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal (QC), H2W 1 S4, Canada

8 Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada

9 Department of Family Medicine, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada

10 Department of Clinical Epidemiology and Biostatistics and Department of Medicine, DeGroote School of Medicine, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, Canada

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BMC Medical Informatics and Decision Making 2012, 12:85  doi:10.1186/1472-6947-12-85

Published: 6 August 2012

Abstract

Background

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 and value-based decisions. Our objective is 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 primary care practice environment.

Methods/design

A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.

Conclusions

This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.

Keywords:
(3–10); Evidence-based practice; Continuing professional education; Risk communication; Patient-centered care; Counselling; Clinical topic summary; Decision support; Knowledge translation; Implementation science