Clinicians' perceptions of digital vs. paper-based decision support interventions.

RATIONALE, AIMS AND OBJECTIVES: Despite extensive evidence on the value of patient decision support interventions (DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice. METHODS: Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach. RESULTS: Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site. CONCLUSIONS: Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption.

Physicians' perceptions of shared decision-making behaviours: a qualitative study demonstrating the continued chasm between aspirations and clinical practice.

BACKGROUND: Shared Decision Making (SDM) is a process of engaging patients in health decisions that involve multiple medically appropriate treatment options. Despite growing public and policy support for patient engagement in health decisions, SDM is not widely practiced in clinical settings. OBJECTIVE: The purpose of our study was to explore clinicians' attitudes, beliefs and perceived social norms about engaging in SDM behaviours. DESIGN: Semi-structured qualitative interviews were conducted with physicians in five practice areas. SETTING AND PARTICIPANTS: This study was conducted at an academic medical centre in St. Louis, MO. The final sample included 20 physicians: five surgeons, five OB/GYNs, four medical oncologists, five internists and one emergency medicine physician. RESULTS: Clinicians described a number of beliefs and cultural- and system-level obstacles to the widespread implementation of SDM, such as how to engage in discussions of cost, uncertainty and clinical equipoise and how to engage patients across various socioeconomic backgrounds. CONCLUSION: Although a large number of participants expressed general support for incorporating SDM into practice, most held fundamentally inconsistent beliefs about practicing specific SDM behaviours. More extensive training of physicians at all levels (pre- and post-licensure) can help increase clinicians' confidence in SDM skills. Developing methods of integrating SDM into the institutional framework of hospitals and training programmes could also increase clinicians' motivation to practice SDM and work to change the culture of medicine such that SDM behaviours are supported.