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Implementing decision aids in clinical practice: A work in (slow) progress

Roger Luckman, Mary E Cooley, Ruth M Tappen

Abstract


Aims and Objectives: While availability of and access to decision aids (DA) addressing many clinical issues has improved greatly in recent years, several significant barriers to adoption and use need to be addressed and overcome before effective DA implementation becomes widespread.

Methods: Interviews with scholars familiar with DA implementation and a literature review.

Results: We have identified and described 22 barriers: 9 workflow barriers, 2 key limitations in resources, 3 concerns about DA quality and availability, 7 provider/patient barriers and uncertainty about the characteristics of effective DAs.  

Discussion: Workflow barriers may be among the most challenging to overcome. Effectively addressing them may require significant investment of resources, complex re-engineering of workflow, reconfiguration of clinical facilities and introduction of new computer hardware. We classify and review the strengths and weaknesses of workflow and physical locations of DA use and of DA formats. We also propose a classification of the dimensions of clinical decisions that may have implications for DA content and design.

Conclusion: We conclude that more rapid progress in DA implementation may depend on new opportunities to increase the time allocated to clinical encounters expected to come from the adoption of value-based reimbursement and on research focused on workflow challenges and DA formats.


Keywords


Barriers, classification, decision aids, facilitators, implementation, information technology, patient navigators, person-centered healthcare, rate of progress, service reconfiguration

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References


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DOI: http://dx.doi.org/10.5750/ejpch.v7i1.1614

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