Paudel Roshan, Ferrante Stephanie, Woodford Jessica, Maitland Conrad, Stockall Eric, Maatman Thomas, Lane Giulia I, Berry Donna L, Sales Anne E, Montie James E
Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.
Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI, USA.
Implement Sci Commun. 2021 Mar 6;2(1):27. doi: 10.1186/s43058-021-00125-w.
The American Urological Association White Paper on Implementation of Shared Decision Making (SDM) into Urological Practice suggested SDM represents the state of the art in counseling for patients who are faced with difficult or uncertain medical decisions. The Michigan Urological Surgery Improvement Collaborative (MUSIC) implemented a decision aid, Personal Patient Profile-Prostate (P3P), in 2018 to help newly diagnosed prostate cancer patients make shared decisions with their clinicians. We conducted a qualitative study to assess statewide implementation of P3P throughout MUSIC.
We recruited urologists and staff from 17 MUSIC practices (8 implementation and 9 comparator practices) to understand how practices engaged patients on treatment discussions and to assess facilitators and barriers to implementing P3P. Interview guides were developed based on the Tailored Interventions for Chronic Disease (TICD) Framework. Interviews were transcribed for analysis and coded independently by two investigators in NVivo, PRO 12. Additionally, quantitative program data were integrated into thematic analyses.
We interviewed 15 urologists and 11 staff from 16 practices. Thematic analysis of interview transcripts indicated three key themes including the following: (i) P3P is compatible as a SDM tool as over 80% of implementation urologists asked patients to complete the P3P questionnaire routinely and used P3P reports during treatment discussions; (ii) patient receptivity was demonstrated by 370 (50%) of newly diagnosed patients (n = 737) from 8 practices enrolled in P3P with 78% completion rate, which accounts for 39% of all newly diagnosed patients in these practices; and (iii) urologists' attitudes towards SDM varied. Over a third of urologists stated they did not rely on a decision aid. Comparator practices indicated habit, inertia, or concerns about clinic flow as reasons for not adopting P3P and some were unconvinced a decision aid is needed in their practice.
Urologists and staff affiliated with MUSIC implementation sites indicated that P3P focuses the treatment discussion on items that are important to patients. Experiences of implementation practices indicate that once initiated, there were no negative effects on clinic flow and urologists indicated P3P saves time during patient counseling, as patients were better prepared for focused discussions. Lack of awareness, personal habits, and inertia are reasons for not implementing P3P among the comparator practices.
美国泌尿外科学会关于在泌尿外科实践中实施共同决策（SDM）的白皮书指出，对于面临困难或不确定医疗决策的患者，共同决策代表了咨询方面的最新技术水平。密歇根泌尿外科手术改进协作组织（MUSIC）在2018年实施了一项决策辅助工具，即个人患者档案-前列腺（P3P），以帮助新诊断的前列腺癌患者与临床医生进行共同决策。我们进行了一项定性研究，以评估P3P在整个MUSIC中的全州实施情况。
我们从17个MUSIC医疗机构（8个实施机构和9个对照机构）招募了泌尿科医生和工作人员，以了解这些机构如何让患者参与治疗讨论，并评估实施P3P的促进因素和障碍。访谈指南是根据慢性病定制干预（TICD）框架制定的。访谈内容被转录用于分析，并由两名研究人员在NVivo PRO 12中独立编码。此外，定量项目数据被纳入主题分析。
我们采访了来自16个机构的15名泌尿科医生和11名工作人员。访谈记录的主题分析表明有三个关键主题，包括：（i）P3P作为一种共同决策工具是合适的，因为超过80%的实施机构的泌尿科医生常规要求患者填写P3P问卷，并在治疗讨论中使用P3P报告；（ii）来自8个参与P3P的机构的370名（50%）新诊断患者（n = 737）表现出患者接受度，完成率为78%，占这些机构所有新诊断患者的39%；（iii）泌尿科医生对共同决策的态度各不相同。超过三分之一的泌尿科医生表示他们不依赖决策辅助工具。对照机构表示习惯、惰性或对诊所流程有担忧是不采用P3P的原因，一些人不相信他们的实践中需要决策辅助工具。
与MUSIC实施机构相关的泌尿科医生和工作人员表示，P3P将治疗讨论聚焦于对患者重要的项目上。实施机构的经验表明，一旦启动，对诊所流程没有负面影响，泌尿科医生表示P3P在患者咨询期间节省了时间，因为患者为有重点的讨论做好了更好的准备。缺乏认识、个人习惯和惰性是对照机构中不实施P3P的原因。
