TY - JOUR
T1 - What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration
AU - Joseph-Williams, N.
AU - Abhyankar, P.
AU - Boland, L.
AU - Bravo, P.
AU - Brenner, A.T.
AU - Brodney, S.
AU - Coulter, A.
AU - Giguere, A.
AU - Hoffman, A.
AU - Korner, M.
AU - Langford, A.
AU - Legare, F.
AU - Matlock, D.
AU - Moumjid, N.
AU - Munro, S.
AU - Steffensen, K.D.
AU - Stirling, C.
AU - van der Weijden, T.
AU - International Patient Decision Aids (IPDAS) Collaboration
PY - 2021/10
Y1 - 2021/10
N2 - BackgroundDecades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting.AimThis review was conducted in response to the IPDAS Collaboration's evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings.MethodsRapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research.ResultsWe developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve.ConclusionsWe recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.
AB - BackgroundDecades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting.AimThis review was conducted in response to the IPDAS Collaboration's evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings.MethodsRapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research.ResultsWe developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve.ConclusionsWe recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.
KW - implementation
KW - patient decision aids
KW - rapid realist review
KW - realist methods
KW - shared decision making
U2 - 10.1177/0272989X20978208
DO - 10.1177/0272989X20978208
M3 - (Systematic) Review article
C2 - 33319621
SN - 0272-989X
VL - 41
SP - 907
EP - 937
JO - Medical Decision Making
JF - Medical Decision Making
IS - 7
M1 - 0272989X20978208
ER -