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Logo of bmcmidmBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Medical Informatics and Decision Making
 
BMC Med Inform Decis Mak. 2012; 12: 85.
Published online 2012 August 6. doi:  10.1186/1472-6947-12-85
PMCID: PMC3472191
Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol
Anik Giguere,corresponding author1 Michel Labrecque,2 Roland Grad,3 Michel Cauchon,4 Matthew Greenway,5 France Légaré,6 Pierre Pluye,7 Stephane Turcotte,8 Lisa Dolovich,9 and R Brian Haynes10
1Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada
2Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada
3Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal (QC), H2W 1 S4, Canada
4Dept. of Family and Emergency Medicine, Laval University Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, Local 4617, Québec (QC), G1V 0A6, Canada
5Department of Family Medicine, McMaster University, 118 Lake Street, Saint-Catharines, ON, Canada
6Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada
7Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal (QC), H2W 1 S4, Canada
8Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada
9Department of Family Medicine, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada
10Department of Clinical Epidemiology and Biostatistics and Department of Medicine, DeGroote School of Medicine, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, Canada
corresponding authorCorresponding author.
Anik Giguere: anikgiguere/at/videotron.ca; Michel Labrecque: Michel.Labrecque/at/fmed.ulaval.ca; Roland Grad: roland.grad/at/mcgill.ca; Michel Cauchon: Michel.Cauchon/at/fmed.ulaval.ca; Matthew Greenway: greenwam/at/mcmaster.ca; France Légaré: France.Legare/at/mfa.ulaval.ca; Pierre Pluye: pierre.pluye/at/mcgill.ca; Stephane Turcotte: Stephane.Turcotte/at/crchul.ulaval.ca; Lisa Dolovich: ldolovic/at/mcmaster.ca; R Brian Haynes: bhaynes/at/mcmaster.ca
Received July 22, 2012; Accepted July 23, 2012.
Abstract
Background
Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.
Methods/design
A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.
Conclusions
This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.
Keywords: (3–10), Evidence-based practice, Continuing professional education, Risk communication, Patient-centered care, Counselling, Clinical topic summary, Decision support, Knowledge translation, Implementation science
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