Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States.
Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States.
Appl Clin Inform. 2022 Jan;13(1):1-9. doi: 10.1055/s-0041-1740481. Epub 2022 Jan 5.
Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka "app") to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid.
The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics.
This work deals with a multicenter qualitative study in rural and urban settings.
A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff.
Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis.
Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information.
Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability.
R01CA218416-A1.
知情决策辅助工具在患者价值观的背景下提供信息，从而改善知情决策（IDM）。为了克服阻碍 IDM 的障碍，我们的团队开发了一种创新的基于 iPad 的应用程序（简称“应用程序”），以帮助患者对结直肠癌筛查做出明智的决策。该应用程序评估患者的筛查资格，向他们介绍选择，并通过互动决策辅助工具授权他们请求进行测试。
本研究旨在探索如何成功地在初级保健诊所实施知情决策辅助工具，包括实施的促进因素和障碍；最小化障碍的策略；草案培训材料的充分性；以及诊所所需的任何额外支持或培训。
这是一项在农村和城市环境中进行的多中心定性研究。
共有 48 人参与，包括初级保健实践经理、临床医生、护士和前台工作人员。
焦点小组和半结构化访谈，数据分析采用主题分析指导。
突出的新兴主题包括时间、工作流程、患者年龄、文化程度和电子健康记录（EHR）集成。对大多数参与者来说，节省时间很重要。患者流量是所有诊所工作人员关注的问题，他们表示，如果患者使用 iPad 模块或诊所工作人员认为额外工作导致流程减缓，会降低工作人员使用该程序的积极性。参与者担心老年患者不愿意或无法使用 iPad，以及文化程度低的患者无法阅读或理解信息。
将新的 IDM 应用程序以最小的干扰整合到当前的诊所工作流程中，将增加长期采用和最终可持续性的可能性。
R01CA218416-A1。
