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 Scijournal_title
Implementation science : ISauthors
Wyatt KD,Branda ME,Anderson RT,Pencille LJ,Montori VM,Hess EP,Ting HH,LeBlanc Adoi
10.1186/1748-5908-9-26subject
Has Abstractpub_date
2014-02-22 00:00:00pages
26issn
1748-5908pii
1748-5908-9-26journal_volume
9pub_type
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