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

Implementation Science

Annie LeBlanc⁵  Henry H Ting³  Erik P Hess⁴  Victor M Montori²  Laurie J Pencille⁷  Ryan T Anderson¹  Megan E Branda⁶  Kirk D Wyatt⁷ 

[1] Mayo Medical School, Mayo Clinic College of Medicine, 200 First St. SW, 55905 Rochester, MN, USA;Department of Medicine, Division of Endocrinology, Mayo Clinic, 200 First St. SW, Rochester, MN, USA;Department of Cardiology, Mayo Clinic, 200 First St. SW, Rochester, MN, USA;Department of Emergency Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, USA;Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, 200 First St. SW, 55905 Rochester, MN, USA;Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St. SW, Rochester, MN, USA;Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First St. SW, Rochester, MN, USA

关键词: Patient-centered care;    Patient involvement;    Fidelity;    Meta-analysis;    Decision aids;    Shared decision making;   

Others  :  805357
DOI  :  10.1186/1748-5908-9-26

 received in 2013-05-09, accepted in 2014-02-13,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Wyatt et al.; licensee BioMed Central Ltd.

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