Decision aids in routine practice: lessons from the breast cancer initiative.

Abstract

BACKGROUND: Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. OBJECTIVE: To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. DESIGN: Structured individual interviews. SETTING AND PARTICIPANTS: A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. MAIN OUTCOME MEASURES: Usage data, barriers to and resources for implementing the PtDAs. RESULTS: Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. CONCLUSIONS: It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals.