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Table 1 Development and Refinement of MyDiabetesPlan and its implementation plan based on identified barriers and facilitators from literature and interviews

From: Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development

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

Email

 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

  1. HCP Healthcare professional, FAQ Frequently-asked questions, EMR Electronic medical record, FHT Family health team