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Identifying Patient Engagement Strategies and Challenges in Patient-Centered Clinical Decision Support (PC CDS): Case Studies of Federally Funded CDS Projects
ABSTRACT
Background:
Patient-centered clinical decision support (PC CDS) encompasses a spectrum of decision making tools that significantly incorporate patient-centered factors related to knowledge, data, delivery, and use. PC CDS supports patient-centered care by helping clinicians and patients make the best decisions given each individual’s circumstances and preferences. However, effectively engaging patients throughout the PC CDS lifecycle remains a challenge.
Objective:
This paper explores patient engagement challenges and mitigation strategies used in real-world PC CDS implementation projects.
Methods:
This qualitative study examined 12 real-world PC CDS implementation projects funded by the Agency for Healthcare Research and Quality. The selected real-world case studies facilitated exploration of patient engagement processes and identification of challenges and strategies to promote patient involvement, improve PC CDS usability, and facilitate integration into patient lifeflows—or patient daily activities. Data were collected through document review and semistructured interviews with researchers from the included projects. Interview transcripts were analyzed to identify key themes related to patient engagement, challenges, mitigation strategies, and future directions for enhancing patient engagement in PC CDS design, implementation, and adoption.
Results:
The study identified six patient engagement challenges: (1) underrepresentation of certain populations among study participants, (2) limited patient participation during group co-design sessions, (3) misalignment of co-design feedback with actionable PC CDS design enhancements, (4) inadequate staff and resources to synthesize patient feedback, (5) low adoption of patient-facing technology, and (6) limited PC CDS fit into patient lifeflows. Our analysis also identified multiple strategies to mitigate these identified challenges. Mitigation strategies include increasing study representativeness, fostering trust, dedicating multidisciplinary team resources, establishing iterative feedback loops, leveraging user-centered design sessions, promoting co-design, prioritizing ease of use, and using participatory research methods to achieve meaningful patient engagement to enhance tool usability and relevance.
Conclusions:
Collectively, the challenges and solutions underscore the principle that patient-centered, participatory design is essential for creating effective PC CDS. Engaging patients early and continuously, addressing health and digital literacy barriers, and integrating feedback throughout the development process ensure that PC CDS meets the needs of varying populations. Future efforts should focus on sustaining engagement, exploring community-based participatory research, and refining health literacy assessments to optimize PC CDS tools for clinical practice.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.