Digital encounter decision aids linked to clinical practice guidelines: results from user testing SHARE-IT decision aids in primary care.
Decision aids
Digital
Evidence-based medicine
General practitioner
Interview
Patient decision aids
Patient participation
Patient-centered communication
Primary care
Qualitative research
Shared decision making
Think aloud
User testing
Journal
BMC medical informatics and decision making
ISSN: 1472-6947
Titre abrégé: BMC Med Inform Decis Mak
Pays: England
ID NLM: 101088682
Informations de publication
Date de publication:
22 05 2023
22 05 2023
Historique:
received:
13
10
2022
accepted:
27
04
2023
medline:
24
5
2023
pubmed:
23
5
2023
entrez:
22
5
2023
Statut:
epublish
Résumé
Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners' (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care. We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis. Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source. This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training. The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
Sections du résumé
BACKGROUND
Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners' (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care.
METHODS
We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis.
RESULTS
Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source.
CONCLUSIONS
This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training.
TRIAL REGISTRATION
The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
Identifiants
pubmed: 37217915
doi: 10.1186/s12911-023-02186-4
pii: 10.1186/s12911-023-02186-4
pmc: PMC10201505
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
97Informations de copyright
© 2023. The Author(s).
Références
Medicine (Baltimore). 2020 Aug 7;99(32):e21389
pubmed: 32769870
Med Decis Making. 2021 Oct;41(7):907-937
pubmed: 33319621
BMJ. 2015 Feb 10;350:g7624
pubmed: 25670178
Med Decis Making. 2019 Oct;39(7):805-815
pubmed: 31423911
J Clin Epidemiol. 2021 Jan;129:104-113
pubmed: 33049326
BMJ. 2012 Jan 27;344:e256
pubmed: 22286508
Med Decis Making. 2010 Jan-Feb;30(1):35-44
pubmed: 19692709
Health Expect. 2015 Aug;18(4):542-61
pubmed: 23451939
J Pediatr Oncol Nurs. 2008 Jul-Aug;25(4):220-6
pubmed: 18539907
Soc Sci Med. 2008 Jan;66(2):362-75
pubmed: 17950508
Anesth Analg. 2019 May;128(5):837-838
pubmed: 30994541
J Clin Epidemiol. 2011 Apr;64(4):401-6
pubmed: 21208779
Int J Nurs Stud. 2012 Mar;49(3):360-71
pubmed: 21996649
Patient Educ Couns. 2009 Mar;74(3):295-301
pubmed: 19150199
BMJ. 2016 Sep 28;354:i5191
pubmed: 27680768
Soc Sci Med. 1997 Mar;44(5):681-92
pubmed: 9032835
J Clin Epidemiol. 2010 Jun;63(6):607-19
pubmed: 20434023
Med Decis Making. 2016 May;36(4):427-52
pubmed: 26585293
Med Decis Making. 2014 Nov;34(8):987-95
pubmed: 25224366
N Engl J Med. 2012 Mar 1;366(9):780-1
pubmed: 22375967
BMC Med Inform Decis Mak. 2021 Jun 29;21(1):202
pubmed: 34187484
BMJ. 2018 Sep 5;362:k3581
pubmed: 30185545
J Gen Intern Med. 2011 Dec;26(12):1411-7
pubmed: 21792695
JMIR Res Protoc. 2013 Jul 10;2(2):e23
pubmed: 23842038
Patient Educ Couns. 2010 Mar;78(3):316-28
pubmed: 20005067
BMJ Open. 2019 Jun 21;9(6):e026488
pubmed: 31230005
BMJ. 2017 Sep 20;358:j4090
pubmed: 28931507
PLoS One. 2014 Apr 15;9(4):e94670
pubmed: 24736389
J Gen Intern Med. 2012 Oct;27(10):1361-7
pubmed: 22618581
Patient Educ Couns. 2019 May;102(5):817-841
pubmed: 30612829
AMA Arch Intern Med. 1956 May;97(5):585-92
pubmed: 13312700
Am Fam Physician. 2015 Jul 15;92(2):118-24
pubmed: 26176370
Fam Med. 2009 May;41(5):350-5
pubmed: 19418284
Implement Sci. 2008 Dec 31;3:57
pubmed: 19117509
Implement Sci. 2016 Aug 08;11:114
pubmed: 27502770
J Intern Med. 2022 Apr;291(4):408-425
pubmed: 34700363
Implement Sci. 2014 Feb 22;9:26
pubmed: 24559190
Med Decis Making. 2010 Nov-Dec;30(6):701-11
pubmed: 21088131
J Innov Health Inform. 2016 Oct 10;23(3):860
pubmed: 28059694
Patient Educ Couns. 2019 Nov;102(11):1946-1948
pubmed: 31582048
BMJ. 2017 May 10;357:j1982
pubmed: 28490431
BMJ. 2019 May 14;365:l2006
pubmed: 31088853
JAMA. 2004 May 19;291(19):2359-66
pubmed: 15150208
BMC Med Inform Decis Mak. 2016 Apr 21;16:45
pubmed: 27098100
Cochrane Database Syst Rev. 2017 Apr 12;4:CD001431
pubmed: 28402085
BMC Med Inform Decis Mak. 2013;13 Suppl 2:S5
pubmed: 24625191
J Eval Clin Pract. 2021 Aug;27(4):926-934
pubmed: 33164316
BMJ. 2018 Feb 6;360:k243
pubmed: 29437651