Winter 2021 (Volume 31, Number 4)
Strategies for
Implementing
Decision Aids in Rheumatology Practice
By Claire Barber, MD, PhD, FRCPC; Nicole Spencer, MSc; and Glen Hazlewood, MD, PhD, FRCPC
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The following is an overview of a CIORA-funded study: Barber CEH, Spencer N, Bansback N, et al.
Development of an implementation strategy for patient decision aids in rheumatoid arthritis through
application of the behavior change wheel. ACR Open Rheumatol. 2021; 3(5):312-323. doi: 10.1002/acr2.11250
What Is Shared Decision-making (SDM) and What Tools
Are Available to Facilitate SDM?Shared decision-making
(SDM) refers to deliberate efforts to involve patients in
treatment and healthcare decisions in a way that incorporates
their preferences and values.1 Patient decision aids are
tools healthcare providers (HCPs) and patients can use to
facilitate SDM.2 Effective decision aids have the following
features: 1) they explain the decision and the options; 2)
they describe the benefits, harms, and uncertainties of the
options; 3) they clarify patient values; and 4) they do not
promote one option over the others.2 Decision aids have
been developed to support guideline-based rheumatology
care in Canada and elsewhere. However, strategies for their
implementation have not been widely investigated.
Objective:The objective of this CIORA-funded study was
to identify facilitators and barriers to decision aid use in
rheumatoid arthritis (RA) within a behaviour change model
to inform an implementation strategy. Using an early
RA decision aid, perspectives were obtained from Canadian
rheumatology HCPs and individuals living with RA about
the facilitators and barriers to decision aid implementation.
Data were generated through semi-structured interviews,
transcribed, and analyzed by inductive thematic analysis.
The lessons learned were developed and mapped to the
behaviour change wheel COM-B system (where Capability,
Opportunity and Motivation interact to influence Behaviour)
to inform elements of an implementation strategy.3
Summary of Study Results:Fifteen HCPs and fifteen patients
were interviewed. Five lessons were generated from
their shared knowledge. The first lesson is that paternalistic
decision-making is a dominant practice in early RA.
Second, patient participation in SDM could be facilitated
by providing patients with emotional support and access to educational tools. Next, current care models across Canada
present many logistical barriers to decision aid implementation.
The fourth lesson is that flexibility is necessary for
successful implementation. Finally, HCPs have limited interest
in training opportunities about decision aids. Implementation
recommendations included the following: 1) provide
patients with direct access to decision aids and SDM
education; 2) create a SDM rheumatology curriculum for
trainees;
3) leverage allied health team members or patient
partners as peer support; 4) link decision aids to rheumatology
guidelines to drive practice change; and 5) design
trials of patient decision aid/SDM interventions to evaluate
patient-important outcomes. Overall, a multifaceted strategy
is suggested to improve uptake of decision aids.
Where to find out more:The full results of this study
have been published in ACR Open: see above for citation.
References:
1. Bae J-M. Shared decision making: relevant concepts and facilitating strategies. Epidemiol Health.
2017; 39:e2017048-e2017048.
2. Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening
decisions. Cochrane Database Syst Rev. 2017; 4(4):Cd001431.
3. Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising
and designing behaviour change interventions. Implementation Science. 2011;6(1):42.
Claire Barber, MD, PhD, FRCPC
Associate Professor,
Departments of Medicine and Community Health Sciences,
Cumming School of Medicine,
University of Calgary, Calgary, Alberta
Glen Hazlewood, MD, PhD, FRCPC
Associate Professor,
Departments of Medicine and Community Health Sciences,
Cumming School of Medicine,
University of Calgary, Calgary, Alberta
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