JMIR Publications

ABSTRACT

Background:

Patient decision aid (PDAs) are important tools that support informed decision-making by the patient based on evidence-based treatment options. PDAs can increase patient knowledge, reduce decisional regret, and engage the provider and patient in meaningful dialog. Despite proven effectiveness in enhancing patient-centered care and improve outcomes, a gap remains of implementing PDAs in routine clinical workflows.

Objective:

This qualitative study produced insight into the needs and preferences of health care providers (HCP) using a clinician-facing navigator app that surfaces relevant PDA tools for shared decision making. The Navigator app is a component of the Shared Decision Aid Navigator System (SEDANS) that is embedded in the electronic health record (EHR).

Methods:

We conducted 13 semi-structured interviews with HCPs who were recruited from four academic medical centers. Interviews included a demonstration of the SEDANS Navigator app. Questions focused on HCP needs and requirements, the clinician context of use, and affordances and barriers to using the system. Themes were identified through summative content analysis, consensus coding, and data reduction.

Results:

We identified three themes: (1) Streamlined functionality may simplify workflow and decrease the burden of shared decision-making, (2) Effective use requires HCP to possess appropriate competencies to use both the Navigator and relevant PDAs, and (3) HCP trust in the Navigator is required to subsequently build patient trust in PDAs. HCPs unanimously shared that SEDANS Navigator should be integrated into the existing workflow. To accomplish this clear priority, clinicians stated that they needed the requisite competencies to successfully use the tool and build trust both with the tool itself and with the patients who would potentially benefit from the use of PDAs and the shared decision-making interaction.

Conclusions:

Tools designed and developed to support PDA use must be integrated into the existing workflow efficiently to create an opportunity for uptake of the technology by busy HCPs. If the SEDANS Navigator can operationalize the cumbersome process of documenting the use of PDAs, more HCPs may potentially use PDAs with their patients, given the right context and appropriate PDA.