Thompson Jocelyn S, Matlock Daniel D, Morris Megan A, McIlvennan Colleen K, Allen Larry A
Adult and Child Consortium for Health Outcomes Research and Delivery Science.
MDM Policy Pract. 2018 Apr 20;3(1):2381468318767658. doi: 10.1177/2381468318767658. eCollection 2018 Jan-Jun.
Although patient decision aids (PtDAs) have been shown to improve patient knowledge and satisfaction, they are infrequently used in the real world. We aimed to understand how our publicly available PtDAs developed for destination therapy left ventricular assist device (DT LVAD) were implemented in clinical practice and characterize factors influencing adoption. We contacted 39 people, 31 who had independently emailed inquiring about our DT LVAD PtDAs and 8 identified through snowball sampling. Thirty people from 23 programs participated in semistructured interviews, which were analyzed using normalization process theory. Eleven programs currently use the PtDAs, 5 plan to use them but have not yet, and 7 do not currently use them nor have active plans to use them. Due to major tradeoffs and preference sensitivity of the DT LVAD decision, participants recognized a role for shared decision making and a need for significant information transfer. Due to a relative lack of resources, participants saw the PtDAs as a way to help facilitate a higher quality decision-making process. Limited time, lack of personnel, and perceived burden to implementing system-level change were cited as barriers to use. Initial implementation was accomplished by a champion of the PtDAs. Actual use of the PtDAs most commonly occurred through LVAD coordinators at the start of formal patient teaching sessions, where the PtDAs could be integrated into the existing LVAD consent and education structure. Interest in and implementation of PtDAs occurred independently at several LVAD programs due to a favorable decisional context, including a perceived role for shared decision making in the high-stakes decision around DT LVAD, unmet informational needs, preexisting education sessions, and invested clinical champions.
尽管患者决策辅助工具（PtDAs）已被证明能提高患者的知识水平和满意度，但在现实世界中却很少被使用。我们旨在了解我们为目标治疗左心室辅助装置（DT LVAD）开发的公开可用的PtDAs在临床实践中是如何实施的，并确定影响其采用的因素。我们联系了39人，其中31人通过独立发电子邮件询问我们的DT LVAD PtDAs，另外8人是通过滚雪球抽样确定的。来自23个项目的30人参与了半结构化访谈，并使用规范化过程理论进行分析。11个项目目前正在使用PtDAs，5个项目计划使用但尚未使用，7个项目目前既不使用也没有使用它们的积极计划。由于DT LVAD决策存在重大权衡和偏好敏感性，参与者认识到共同决策的作用以及大量信息传递的必要性。由于相对缺乏资源，参与者将PtDAs视为有助于促进更高质量决策过程的一种方式。有限的时间、人员短缺以及实施系统层面变革的感知负担被认为是使用的障碍。最初的实施是由PtDAs的倡导者完成的。PtDAs的实际使用最常见的是在正式患者教学课程开始时由LVAD协调员进行，在那里PtDAs可以融入现有的LVAD同意和教育结构中。由于有利的决策环境，包括在围绕DT LVAD的高风险决策中共同决策的感知作用、未满足的信息需求、预先存在的教育课程以及投入其中的临床倡导者，几个LVAD项目对PtDAs的兴趣和实施是独立发生的。
