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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
 Patient-directed   Paper/internet DA
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
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