The UPFRONT project: tailored implementation and evaluation of a patient decision aid to support shared decision-making about management of symptomatic uterine fibroids

被引:0
作者
Forcino, Rachel C. [1 ]
Durand, Marie-Anne [2 ,3 ,4 ]
Schubbe, Danielle [2 ]
Engel, Jaclyn [2 ]
Banks, Erika [5 ]
Laughlin-Tommaso, Shannon K. [6 ]
Foster, Tina [7 ]
Madden, Tessa [8 ]
Anchan, Raymond M. [9 ]
Politi, Mary [10 ]
Lindholm, Anne [9 ]
Gargiulo, Rossella M. [9 ]
Seshan, Maya [9 ]
Tomaino, Marisa [11 ]
Zhang, Jingyi [2 ]
Acquilano, Stephanie C. [2 ]
Akinfe, Sade [2 ]
Sharma, Anupam [2 ]
Aarts, Johanna W. M. [12 ,13 ]
Elwyn, Glyn [2 ]
机构
[1] Univ Kansas, Sch Med, Dept Populat Hlth, Kansas City, KS 66103 USA
[2] Dartmouth Coll, Dartmouth Inst Hlth Policy & Clin Practice, Geisel Sch Med, Lebanon, NH USA
[3] Univ Toulouse, CERPOP, Inserm, UPS, Toulouse, France
[4] Unisante, Ctr Univ Med Gen & Sante Publ, Lausanne, Switzerland
[5] NYU Langone Long Isl, Dept Obstet & Gynecol, Mineola, NY USA
[6] Mayo Clin, Dept Obstet & Gynecol, Rochester, MN USA
[7] Dartmouth Hitchcock Hlth, Dept Obstet & Gynecol, Lebanon, NH USA
[8] Yale Sch Med, Dept Obstet Gynecol & Reprod Sci, New Haven, CT USA
[9] Harvard Med Sch, Brigham & Womens Hosp, Dept Obstet Gynecol & Reprod Biol, Boston, MA USA
[10] Washington Univ, Sch Med, Dept Surg, Div Publ Hlth Sci, St Louis, MO USA
[11] Rutgers Hlth, Rutgers Inst Nicotine & Tobacco Studies, New Brunswick, NJ USA
[12] Amsterdam UMC, Dept Obstet & Gynaecol, Amsterdam, Netherlands
[13] Canc Ctr Amsterdam, Gynaecol Oncol, Amsterdam, Netherlands
关键词
Shared decision making training; Patient decision aid; Conversation aid; Symptomatic uterine fibroids; Implementation science; REPORTED MEASURE; HEALTH; COLLABORATE; KNEE;
D O I
10.1186/s13012-024-01404-5
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
ObjectiveTo evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States.MethodsWe used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use.ResultsThe decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16-2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22).ConclusionWhen patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making.Trial registrationClinicalTrials.gov NCT03985449; registered 6 June 2019.
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页数:13
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