Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters.

Abstract:

OBJECTIVE:To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes. METHODS:Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions. RESULTS:Of 339 encounters in the SDM intervention arm of the trials, 229 were video recorded and available for analysis. The mean proportion of fidelity items observed in each encounter was 58.4% (SD = 23.2). The proportion of fidelity items observed was significantly associated with patient knowledge (p = 0.01) and clinician involvement of the patient in decision making (p <0.0001), while no association was found with patient decisional conflict or satisfaction with the encounter. CONCLUSION:Clinicians' fidelity to usage instructions of point-of-care decision aids in randomized trials was suboptimal during their initial implementation in practice, which may have underestimated the potential efficacy of decision aids when used as intended.

journal_name

Implement Sci

authors

Wyatt KD,Branda ME,Anderson RT,Pencille LJ,Montori VM,Hess EP,Ting HH,LeBlanc A

doi

10.1186/1748-5908-9-26

subject

Has Abstract

pub_date

2014-02-22 00:00:00

pages

26

issn

1748-5908

pii

1748-5908-9-26

journal_volume

9

pub_type

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