Grant: Travel Awards - Institute Community Support

Purpose: Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed, value-based decisions. The objective of this project was to study the barriers and facilitators to using Decision Boxes in clinical practice. Methods: Eight Decision Boxes relevant to primary care were hosted on a website together with a tutorial and education on patient counselling. The Decision Boxes were delivered weekly as email to family physicians, residents and nurses working in primary healthcare clinics. Using a web-questionnaire, clinicians rated each Decision Box with respect to their clinical relevance and cognitive impact. Following the 8-week intervention, interviews with clinicians and clinic administrators were conducted to explore contextual factors influencing the use of the Decision Boxes. Results: One hundred clinicians from six primary care clinics received eight Decision boxes by email and rated them with web-questionnaires. They reported that their practice would be changed after reading the Decision Boxes in 54% of questionnaires, that they would use or possibly use this information for their patients (86%), and that they expected the information to benefit their patients (83%). In focus groups, the same clinicians suggested that giving the patient an additional source of information to read before or after the encounter would facilitate their use of Decision boxes. A few mentioned having to change their attitude towards some interventions because of the uncertainty associated with patient outcomes. Having received prior training in SDM also came out as a facilitator to using the Decision Boxes. Conclusions: The proposed Decision Box approach is valued by clinicians. This project will allow tailoring of Decision Boxes and their delivery to the specific barriers identified to improve the adoption of shared decision making.