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Krah NS, Zietzsch P, Salrach C, Toro CA, Ballester M, Orrego C, Groene O. Identifying Factors to Facilitate the Implementation of Decision-Making Tools to Promote Self-Management of Chronic Diseases into Routine Healthcare Practice: A Qualitative Study. Healthcare (Basel) 2023; 11:2397. [PMID: 37685431 PMCID: PMC10487156 DOI: 10.3390/healthcare11172397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
This study, as part of the COMPAR-EU project, utilized a mixed-methods approach involving 37 individual, semi-structured interviews and one focus group with 7 participants to investigate the factors influencing the implementation and use of self-management interventions (SMIs) decision tools in clinical practice. The interviews and focus group discussions were guided by a tailored interview and focus group guideline developed based on the Tailored Implementation for Chronic Diseases (TICD) framework. The data were analyzed using a directed qualitative content analysis, with a deductive coding system based on the TICD framework and an inductive coding process. A rapid analysis technique was employed to summarize and synthesize the findings. The study identified five main dimensions and facilitators for implementation: decision tool factors, individual health professional factors, interaction factors, organizational factors, and social, political, and legal factors. The findings highlight the importance of structured implementation through SMI decision support tools, emphasizing the need to understand their benefits, secure organizational resources, and gain political support for sustainable implementation. Overall, this study employed a systematic approach, combining qualitative methods and comprehensive analysis, to gain insights into the factors influencing the implementation of SMIs' decision-support tools in clinical practice.
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Affiliation(s)
| | - Paula Zietzsch
- OptiMedis, Research and Innovation, 20095 Hamburg, Germany
| | | | | | - Marta Ballester
- Avedis Donabedian Research Institute, 08037 Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute, 08037 Barcelona, Spain
| | - Oliver Groene
- OptiMedis, Research and Innovation, 20095 Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten/Herdecke, 58455 Witten, Germany
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Todio E, Schofield P, Sharp J. A Qualitative Study of Men's Experiences Using Navigate: A Localized Prostate Cancer Treatment Decision Aid. MDM Policy Pract 2023; 8:23814683231198003. [PMID: 37719768 PMCID: PMC10501076 DOI: 10.1177/23814683231198003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/12/2023] [Indexed: 09/19/2023] Open
Abstract
Background. Men diagnosed with localized prostate cancer (LPC) often face a dilemma in choosing between available treatment options that have similar survival rates but for which the perceived advantages and disadvantages of each treatment differ. The Navigate decision aid was created to assist Australian men with LPC in making informed decisions about treatment that align with their personal values and preferences. Navigate presents current, unbiased information, including an interactive values clarification exercise. Objective. This study was a qualitative investigation of men's treatment decision making for LPC, and their experiences using the Navigate Web site, to identify areas for improvement and inform implementation. Methods. Semi-structured interviews were conducted with 20 men diagnosed with LPC who completed the intervention arm of the Navigate randomized controlled trial. Interview transcripts were thematically analyzed. Results: Five main themes emerged: 1) diagnosis experiences varied, although men were strongly influenced by their clinician to make an early initial treatment decision; 2) men sought resources and support they trusted; 3) men valued Navigate's multiformatted content and design; 4) men suggested more content was needed on a) the diagnosis journey and b) new treatment updates; and 5) men identified design flaws in the values clarification exercise on Navigate but appreciated the tool being available. Conclusions. Specialist authority influenced men to make an early treatment decision. However, Navigate was helpful in supporting men's ongoing treatment decision making, particularly men on active surveillance who may face further treatment decisions if their cancer progresses. To gain trust and improve engagement from Navigate users, credentials and sources of information need to be prominent. Trustworthiness, timing of access, and the clinician's role in empowering men to use available decision aids are crucial elements to be considered when implementing Navigate in clinical settings. Highlights The Navigate decision aid Web site was created to help Australian men diagnosed with localized prostate cancer (LPC) make an informed decision about their treatment.Navigate was helpful in supporting men's ongoing treatment decision making for LPC.Men's treatment decision making for LPC was greatly influenced by perceived authority and trust in their clinician.Trustworthiness, timing of access, and the clinician's role in empowering men to use available decision aids are crucial.
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Affiliation(s)
- Elizabeth Todio
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, VIC, Australia
- Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Jessica Sharp
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
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Hochstenbach LM, Determann D, Fijten RR, Bloemen-van Gurp EJ, Verwey R. Taking shared decision making for prostate cancer to the next level: Requirements for a Dutch treatment decision aid with personalized risks on side effects. Internet Interv 2023; 31:100606. [PMID: 36844795 PMCID: PMC9945792 DOI: 10.1016/j.invent.2023.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 12/16/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Different curative treatment modalities need to be considered in case of localized prostate cancer, all comparable in terms of survival and recurrence though different in side effects. To better inform patients and support shared decision making, the development of a web-based patient decision aid including personalized risk information was proposed. This paper reports on requirements in terms of content of information, visualization of risk profiles, and use in practice. METHODS Based on a Dutch 10-step guide about the setup of a decision aid next to a practice guideline, an iterative and co-creative design process was followed. In collaboration with various groups of experts (health professionals, usability and linguistic experts, patients and the general public), research and development activities were continuously alternated. RESULTS Content requirements focused on presenting information only about conventional treatments and main side effects; based on risk group; and including clear explanations about personalized risks. Visual requirements involved presenting general and personalized risks separately; through bar charts or icon arrays; and along with numbers or words, and legends. Organizational requirements included integration into local clinical pathways; agreement about information input and output; and focus on patients' numeracy and graph literacy skills. CONCLUSIONS The iterative and co-creative development process was challenging, though extremely valuable. The translation of requirements resulted in a decision aid about four conventional treatment options, including general or personalized risks for erection, urinary and intestinal problems that are communicated with icon arrays and numbers. Future implementation and validation studies need to inform about use and value in practice.
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Affiliation(s)
- Laura M.J. Hochstenbach
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands,Corresponding author at: Maastricht University, Department of Health Services Research, P.O. Box 616, 6200 MD, the Netherlands.
| | | | - Rianne R.R. Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Esther J. Bloemen-van Gurp
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands,Expertise Center Empowering Healthy Behavior, Fontys University of Applied Sciences, P.O. Box 347, 5600 AH Eindhoven, the Netherlands
| | - Renée Verwey
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands
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Hackert MQN, Ankersmid JW, Engels N, Prick JCM, Teerenstra S, Siesling S, Drossaert CHC, Strobbe LJA, van Riet YEA, van den Dorpel RMA, Bos WJW, van der Nat PB, van den Berg-Vos RM, van Schaik SM, Garvelink MM, van der Wees PJ, van Uden-Kraan CF. Effectiveness and implementation of SHared decision-making supported by OUTcome information among patients with breast cancer, stroke and advanced kidney disease: SHOUT study protocol of multiple interrupted time series. BMJ Open 2022; 12:e055324. [PMID: 35914919 PMCID: PMC9345077 DOI: 10.1136/bmjopen-2021-055324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Within the value-based healthcare framework, outcome data can be used to inform patients about (treatment) options, and empower them to make shared decisions with their health care professional. To facilitate shared decision-making (SDM) supported by outcome data, a multicomponent intervention has been designed, including patient decision aids on the organisation of post-treatment surveillance (breast cancer); discharge location (stroke) and treatment modality (advanced kidney disease), and training on SDM for health care professionals. The SHared decision-making supported by OUTcome information (SHOUT) study will examine the effectiveness of the intervention and its implementation in clinical practice. METHODS AND ANALYSIS Multiple interrupted time series will be used to stepwise implement the intervention. Patients diagnosed with either breast cancer (N=630), stroke (N=630) or advanced kidney disease (N=473) will be included. Measurements will be performed at baseline, three (stroke), six and twelve (breast cancer and advanced kidney disease) months. Trends on outcomes will be measured over a period of 20 months. The primary outcome will be patients' perceived level of involvement in decision-making. Secondary outcomes regarding effectiveness will include patient-reported SDM, decisional conflict, role in decision-making, knowledge, quality of life, preferred and chosen care, satisfaction with the intervention, healthcare utilisation and health outcomes. Outcomes regarding implementation will include the implementation rate and a questionnaire on the health care professionals' perspective on the implementation process. ETHICS AND DISSEMINATION The Medical research Ethics Committees United in Nieuwegein, the Netherlands, has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. Bureau Onderzoek & Innovatie of Santeon, the Netherlands, approved this study. The results will contribute to insight in and knowledge on the use of outcome data for SDM, and can stimulate sustainable implementation of SDM. TRIAL REGISTRATION NUMBER NL8374, NL8375 and NL8376.
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Affiliation(s)
| | - Jet W Ankersmid
- Santeon Hospital Group, Utrecht, The Netherlands
- Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Noel Engels
- Santeon Hospital Group, Utrecht, The Netherlands
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Janine C M Prick
- Santeon Hospital Group, Utrecht, The Netherlands
- Neurology, OLVG, Amsterdam, The Netherlands
| | - Steven Teerenstra
- Radboud Institute for Health Sciences, Health Evidence, section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sabine Siesling
- Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Luc J A Strobbe
- Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | - Willem Jan W Bos
- Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
- Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul B van der Nat
- Value-Based Health Care, St. Antonius Hospital, Nieuwegein, The Netherlands
- Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Renske M van den Berg-Vos
- Neurology, OLVG, Amsterdam, The Netherlands
- Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | | | - Mirjam M Garvelink
- Value-Based Health Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
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Engels N, van der Nat PB, Ankersmid JW, Prick JCM, Parent E, The R, Takahashi A, Bart HAJ, van Uden-Kraan CF, Stiggelbout AM, Bos WJW, van den Dorpel MA. Development of an online patient decision aid for kidney failure treatment modality decisions. BMC Nephrol 2022; 23:236. [PMID: 35794539 PMCID: PMC9257566 DOI: 10.1186/s12882-022-02853-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient decision aids (PtDAs) support patients and clinicians in shared decision-making (SDM). Real-world outcome information may improve patients’ risk perception, and help patients make decisions congruent with their expectations and values. Our aim was to develop an online PtDA to support kidney failure treatment modality decision-making, that: 1) provides patients with real-world outcome information, and 2) facilitates SDM in clinical practice.
Methods
The International Patient Decision Aids Standards (IPDAS) development process model was complemented with a user-centred and convergent mixed-methods approach. Rapid prototyping was used to develop the PtDA with a multidisciplinary steering group in an iterative process of co-creation. The results of an exploratory evidence review and a needs-assessment among patients, caregivers, and clinicians were used to develop the PtDA. Seven Dutch teaching hospitals and two national Dutch outcome registries provided real-world data on selected outcomes for all kidney failure treatment modalities. Alpha and beta testing were performed to assess the prototype and finalise development. An implementation strategy was developed to guide implementation of the PtDA in clinical practice.
Results
The ‘Kidney Failure Decision Aid’ consists of three components designed to help patients and clinicians engage in SDM: 1) a paper hand-out sheet, 2) an interactive website, and 3) a personal summary sheet. A ‘patients-like-me’ infographic was developed to visualise survival probabilities for each treatment modality on the website. Other treatment outcomes were incorporated as event rates (e.g. hospitalisation rates) or explained in text (e.g. the flexibility of each treatment modality). No major revisions were needed after alpha and beta testing. During beta testing, some patients ignored the survival probabilities because they considered these too confronting. Nonetheless, patients agreed that every patient has the right to choose whether they want to view this information. Patients and clinicians believed that the PtDA would help patients make informed decisions, and that it would support values- and preferences-based decision-making. Implementation of the PtDA has started in October 2020.
Conclusions
The ‘Kidney Failure Decision Aid’ was designed to facilitate SDM in clinical practice and contains real-world outcome information on all kidney failure treatment modalities. It is currently being investigated for its effects on SDM in a clinical trial.
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van der Weijden T, van der Kraan J, Brand PLP, van Veenendaal H, Drenthen T, Schoon Y, Tuyn E, van der Weele G, Stalmeier P, Damman OC, Stiggelbout A. Shared decision-making in the Netherlands: Progress is made, but not for all. Time to become inclusive to patients. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:98-104. [PMID: 35613990 DOI: 10.1016/j.zefq.2022.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
Dutch initiatives targeting shared decision-making (SDM) are still growing, supported by the government, the Federation of Patients' Organisations, professional bodies and healthcare insurers. The large majority of patients prefers the SDM model. The Dutch are working hard to realise improvement in the application of SDM in daily clinical practice, resulting in glimpses of success with objectified improvement on observed behavior. Nevertheless, the culture shift is still ongoing. Large-scale uptake of SDM behavior is still a challenge. We haven't yet fully reached the patients' needs, given disappointing research data on patients' experiences and professional behavior. In all Dutch implementation projects, early adopters, believers or higher-educated persons have been overrepresented, while patients with limited health literacy have been underrepresented. This is a huge problem as 25% of the Dutch adult population have limited health literacy. To further enhance SDM there are issues to be addressed: We need to make physicians conscious about their limited application of SDM in daily practice, especially regarding preference and decision talk. We need to reward clinicians for the extra work that comes with SDM. We need to be inclusive to patients with limited health literacy, who are less often actually involved in decision-making and at the same time more likely to regret their chosen treatment compared to patients with higher health literacy.
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Affiliation(s)
- Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | | | - Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, and UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ton Drenthen
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Yvonne Schoon
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline Tuyn
- Program manager health care innovation, CZ Health Care Insurance, Tilburg, The Netherlands
| | | | - Peep Stalmeier
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C Damman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Anne Stiggelbout
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam and Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, The Netherlands
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Grüne B, Kriegmair MC, Lenhart M, Michel MS, Huber J, Köther AK, Büdenbender B, Alpers GW. Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review. Eur Urol Focus 2021; 8:851-869. [PMID: 33980474 DOI: 10.1016/j.euf.2021.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Decision aids (DAs) aim to support patients in the process of shared decision-making for complex treatment decisions. To improve patient-centered care in uro-oncology, it is essential to evaluate the availability and quality of existing DAs. OBJECTIVE To assess the quality of existing DAs for patients across the most prevalent uro-oncological entities. EVIDENCE ACQUISITION This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A systematic literature search (MedLine, Cochrane Library, Web of Science Core Collection, and CCMed) was conducted to identify DAs for treatment decisions for patients with prostate, renal, or bladder cancer. All studies reporting on the development or evaluation of DAs were included. The DAs were examined based on the International Patient Decision Aid Standards (IPDAS) and the evaluation studies were compared in accordance with Standards for Universal reporting of a patient Decision Aid Evaluations (SUNDAE). EVIDENCE SYNTHESIS The literature search identified 1995 potentially relevant publications. Thirty-two studies reporting on 25 DAs met the inclusion criteria. Twenty-two DAs address prostate cancer, two renal tumor, and one bladder cancer. In the majority of DAs (n = 20), patients can enter individual data. A few (n = 6) DAs allow for personalization using a risk-adapted presentation of treatment options. The percentage of IPDAS criteria met in DAs ranged between 50% and 100% (median 87.5%), and the studies' adherence to the SUNDAE checklist was between 62% and 96% (median 86.6%). Evaluation studies suggest that interventions are likely efficacious. However, a preliminary meta-analysis revealed no significant difference between "DA" and "usual care" for decisional conflict or decisional regret. CONCLUSIONS This review highlights that a number of well-developed DAs exist in urology. However, there is a need for specific instruments targeting kidney and bladder cancer. Personalization of tools and adherence to international standards of DAs should be further improved. PATIENT SUMMARY The majority of uro-oncological decision aids target prostate cancer, whereas fewer address kidney or bladder cancer. The quality of the existing instruments is high, but can be increased further to better address specific needs of individual patients.
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Affiliation(s)
- Britta Grüne
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Maximilian Lenhart
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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Kostick KM, Trejo M, Bhimaraj A, Civitello A, Grinstein J, Horstmanshof D, Jorde UP, Loebe M, Mehra MR, Sulemanjee NZ, Thohan V, Trachtenberg BH, Uriel N, Volk RJ, Estep JD, Blumenthal-Barby JS. A principal components analysis of factors associated with successful implementation of an LVAD decision support tool. BMC Med Inform Decis Mak 2021; 21:106. [PMID: 33743685 PMCID: PMC7980808 DOI: 10.1186/s12911-021-01468-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A central goal among researchers and policy makers seeking to implement clinical interventions is to identify key facilitators and barriers that contribute to implementation success. Despite calls from a number of scholars, empirical insights into the complex structural and cultural predictors of why decision aids (DAs) become routinely embedded in health care settings remains limited and highly variable across implementation contexts. METHODS We examined associations between "reach", a widely used indicator (from the RE-AIM model) of implementation success, and multi-level site characteristics of nine LVAD clinics engaged over 18 months in implementation and dissemination of a decision aid for left ventricular assist device (LVAD) treatment. Based on data collected from nurse coordinators, we explored factors at the level of the organization (e.g. patient volume), patient population (e.g. health literacy; average sickness level), clinician characteristics (e.g. attitudes towards decision aid; readiness for change) and process (how the aid was administered). We generated descriptive statistics for each site and calculated zero-order correlations (Pearson's r) between all multi-level site variables including cumulative reach at 12 months and 18 months for all sites. We used principal components analysis (PCA) to examine any latent factors governing relationships between and among all site characteristics, including reach. RESULTS We observed strongest inclines in reach of our decision aid across the first year, with uptake fluctuating over the second year. Average reach across sites was 63% (s.d. = 19.56) at 12 months and 66% (s.d. = 19.39) at 18 months. Our PCA revealed that site characteristics positively associated with reach on two distinct dimensions, including a first dimension reflecting greater organizational infrastructure and standardization (characteristic of larger, more established clinics) and a second dimension reflecting positive attitudinal orientations, specifically, openness and capacity to give and receive decision support among coordinators and patients. CONCLUSIONS Successful implementation plans should incorporate specific efforts to promote supportive and mutually informative interactions between clinical staff members and to institute systematic and standardized protocols to enhance the availability, convenience and salience of intervention tool in routine practice. Further research is needed to understand whether "core predictors" of success vary across different intervention types.
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Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MC: 420, Houston, TX, 77030, USA.
| | - Meredith Trejo
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MC: 420, Houston, TX, 77030, USA
| | - Arvind Bhimaraj
- Division of Heart Failure, Houston Methodist Hospital, Smith Tower, 6550 Fannin St., Ste 1901, Houston, TX, 77030, USA
| | - Andrew Civitello
- Baylor St. Luke's Medical Center, Texas Heart Institute, 7200 Cambridge Street, Ste 6C, Houston, TX, 77030, USA
| | - Jonathan Grinstein
- Duchossois Center for Advanced Medicine - Hyde Park, University of Chicago Medicine, 5758 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Douglas Horstmanshof
- INTREGIS Advanced Cardiac Care, 3400 N.W. Expressway, Bldg C. Suite 200, Oklahoma City, OK, 73112, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Matthias Loebe
- Miami Transplant Institute, University of Miami Health System, Miami, FL, 33136, USA
| | - Mandeep R Mehra
- Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Nasir Z Sulemanjee
- Aurora St. Luke's Medical Center, 2900 W Oklahoma Ave, Milwaukee, WI, 53215, USA
| | - Vinay Thohan
- Asheville Cardiology Associates, 5 Vanderbilt Park Dr., Asheville, NC, 28803, USA
| | - Barry H Trachtenberg
- Division of Heart Failure, Houston Methodist Hospital, Smith Tower, 6550 Fannin St., Ste 1901, Houston, TX, 77030, USA
| | - Nir Uriel
- Columbia Presbyterian Medical Center, Columbia University Irving Medical Center, 622 West 168th St., Room 129, New York, NY, 10032, USA
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Services, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1465, Houston, TX, USA
| | - Jerry D Estep
- Miller Family Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MC: 420, Houston, TX, 77030, USA
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