Implementation of a cystic fibrosis lung transplant referral patient decision aid in routine clinical practice: an observational study

Implementation Science

Shawn D Aaron⁴  Neil Brown³  Yves Berthiaume⁸  Andreas Freitag⁷  Josette Salgado³  Ranjeeta Mallick¹  Ena Gaudet⁶  Tracy Gooyers⁵  Rosamund Hennessey⁷  Katherine L Vandemheen¹  Dawn Stacey² 

[1] Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa K1H 4E9, ON, Canada;Ottawa Hospital Research Institute, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa K1H 8M5, ON, Canada;University of Alberta, 8440-112 Street, Edmonton T6G 2B7, AB, Canada;Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada;University of Western Ontario, 800 Commissioner’s Rd. E, London N6A 4G5, ON, Canada;The Ottawa Hospital, 501 Smyth Road, Ottawa K1H 4E9, ON, Canada;McMaster University, 1200 Main St. Hamilton, Hamilton L8N 2Z5, ON, Canada;Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W1R7, QC, Canada

关键词: Barriers;    Decision support;    Lung transplantation;    Patient decision aid;    Cystic fibrosis;    Implementation;   

Others  :  1133692
DOI  :  10.1186/s13012-015-0206-4

 received in 2014-07-11, accepted in 2015-01-15,  发布年份 2015

【 摘 要 】

Background

The decision to have lung transplantation as treatment for end-stage lung disease from cystic fibrosis (CF) has benefits and serious risks. Although patient decision aids are effective interventions for helping patients reach a quality decision, little is known about implementing them in clinical practice. Our study evaluated a sustainable approach for implementing a patient decision aid for adults with CF considering referral for lung transplantation.

Methods

A prospective pragmatic observational study was guided by the Knowledge-to-Action Framework. Healthcare professionals in all 23 Canadian CF clinics were eligible. We surveyed participants regarding perceived barriers and facilitators to patient decision aid use. Interventions tailored to address modifiable identified barriers included training, access to decision aids, and conference calls. The primary outcome was >80% use of the decision aid in year 2.

Results

Of 23 adult CF clinics, 18 participated (78.2%) and 13 had healthcare professionals attend training. Baseline barriers were healthcare professionals’ inadequate knowledge for supporting patients making decisions (55%), clarifying patients’ values for outcomes of options (58%), and helping patients handle conflicting views of others (71%). Other barriers were lack of time (52%) and needing to change how transplantation is discussed (42%). Baseline facilitators were healthcare professionals feeling comfortable discussing bad transplantation outcomes (74%), agreeing the decision aid would be easy to experiment with (71%) and use in the CF clinic (87%), and agreeing that using the decision aid would not require reorganization of the CF clinic (90%). After implementing the decision aid with interventions tailored to the barriers, decision aid use increased from 29% at baseline to 85% during year 1 and 92% in year 2 (p < 0.001). Compared to baseline, more healthcare professionals at the end of the study were confident in supporting decision-making (p = 0.03) but continued to feel inadequate ability with supporting patients to handle conflicting views (p = 0.01).

Conclusion

Most Canadian CF clinics agreed to participate in the study. Interventions were used to target identified modifiable barriers to using the patient decision aid in routine CF clinical practice. CF clinics reported using it with almost all patients in the second year.

【 授权许可】

   
2015 Stacey et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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