Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
BMJ Open. 2012 Nov 29;2(6). doi: 10.1136/bmjopen-2012-001530. Print 2012.
To assess whether clinical teams would direct patients to use web-based patient decision support interventions (DESIs) and whether patients would use them.
Retrospective semistructured interviews and web server log analysis.
57 NHS professionals (nurses, doctors and others) in orthopaedic, antenatal, breast, urology clinics and in primary care practices across 22 NHS sites given access to DESIs hosted on the NHS Direct website.
Fewer than expected patients were directed to use the web tools. The most significant obstacles to referral to the tools were the attitudes of clinicians and clinical teams. Technical problems contributed to the problems but the low uptake was mainly explained by clinicians' limited understanding of how patient DESIs could be helpful in clinical pathways, their perception that 'shared decision-making' was already commonplace and that, in their view, some patients are resistant to being involved in treatment decisions. External factors, such as efficiency targets and 'best practice' recommendations were also cited being significant barriers. Clinicians did not feel the need to refer patients to use decision support tools, web-based or not, and, as a result, felt no requirement to change existing practice routines. Uptake is highest when clinicians set expectations that these tools are integral to practice and embed their use into clinical pathways.
Existing evidence of patient benefit and the free availability of patient DESIs via the web are not sufficient drivers to achieve routine use. Health professionals were not motivated to refer patients to these interventions. Clinicians will not use these interventions simply because they are made available, despite good evidence of benefit to patients. These attitudes are deep seated and will not be modified by solely developing web-based interventions: a broader strategy will be required to embed DESIs into routine practice.
评估临床团队是否会引导患者使用基于网络的患者决策支持干预措施（DESI），以及患者是否会使用这些措施。
回顾性半结构化访谈和网络服务器日志分析。
在 NHS Direct 网站上提供访问权限的 22 个 NHS 站点的 57 名 NHS 专业人员（护士、医生和其他人员），包括骨科、产前、乳房、泌尿科诊所和初级保健诊所。
被引导使用网络工具的患者人数少于预期。向这些工具转介的最大障碍是临床医生和临床团队的态度。技术问题也导致了一些问题，但低使用率主要归因于临床医生对患者 DESI 如何在临床路径中有所帮助的理解有限，他们认为“共同决策”已经很普遍，而且在他们看来，有些患者抵制参与治疗决策。外部因素，如效率目标和“最佳实践”建议，也被认为是重大障碍。临床医生认为没有必要向患者推荐使用决策支持工具，无论是基于网络的还是其他的，因此，他们也没有改变现有实践常规的需求。当临床医生期望这些工具是实践的组成部分并将其嵌入临床路径时，使用量最高。
现有的患者受益证据和通过网络免费提供患者 DESI 不足以实现常规使用。卫生专业人员没有动力向患者推荐这些干预措施。尽管有证据表明这些干预措施对患者有益，但临床医生不会仅仅因为这些干预措施可获得就使用这些干预措施。这些态度根深蒂固，仅通过开发基于网络的干预措施无法改变：需要采取更广泛的策略将 DESI 嵌入常规实践中。
