Level | Barrier | Facilitator | Component of implementation strategy |
---|---|---|---|
From Elwyn 2013 review – barriers and facilitators to PtDA implementation | |||
HCP | HCP attitude | HCP engagement throughout process including tool development Training session Training video Enabler card (laminated double-sided FAQ sheet) | |
Lack of training | Training | ||
Lack of trust, agreement with content of decision aid | |||
Lack of time | Interprofessional involvement | ||
Not their role to identify patient | EMR prompt to use tool | ||
Systems | Lack of organizational commitment | Clinical champion, in leadership position | Site investigator +/−other Engagement of FHT throughout process Integrated into usual care |
Systems level process supporting patient identification | EMR prompt to use tool | ||
From Legare 2014 review – barriers and facilitators to SDM | |||
Systems | Barrier assessment | Done via feasibility testing (see below) Done at each site by developing process map with clinical team | |
Provider-directed | Educational meeting/outreach | Training session Practice session | |
Distribution of education material | Training video Enabler card | ||
Audit & feedback | Review whether tool used Review how tools used Follow up phone call (clinical champion) | ||
Reminders | EMR | ||
Patient-directed | Paper/internet DA Pamphlet | PtDA Training video Enabler card | |
Both | Above | ||
From Phase 1 feasibility data | |||
Systems | Lack of organizational commitment | See above | |
HCP | Competing health concerns | See below under patient | |
Lack of time | Scheduled into dedicated visit Assessed in usability Interprofessional approach | ||
Inadequate patient knowledge | See below under patient | ||
Loss of interaction with patient | See below under patient | ||
Complexity | Assessed in usability Training | ||
Length | Assessed in usability Warn that first time is longer +/− prefill depending on use | ||
Flow sheet | Plan to be pasted into EMR medical note and made searchable | ||
Note from other HCP in EMR | |||
Engaged team | Engagement of FHT throughout process Train all team members | ||
Patient | Inadequate knowledge about own health | Dialog, listening | Use with HCP in first phase During HCP user training, emphasize role of tool in enabling dialog, importance of listening |
Inadequate knowledge about disease | Tool as springboard for discussion Tool provides information about disease management options | ||
Denial | Addressed in tool under health beliefs section | ||
Competing health concerns | Scheduled to use during dedicated diabetes visit | ||
Competing life issues | Acknowledged in initial screening phase of tool |