title: Decision aids in routine practice: lessons from the breast cancer initiative.
abstract: BACKGROUND
  Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice.
  
  
  OBJECTIVE
  To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care.
  
  
  METHODS
  Structured individual interviews.
  
  
  METHODS
  A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres.
  
  
  METHODS
  Usage data, barriers to and resources for implementing the PtDAs.
  
  
  RESULTS
  Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems.
  
  
  CONCLUSIONS
  It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals.
authors.affiliation: Health Decision Research Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Silvia
authors.forename: Karen R
authors.initials: KR
authors.lastname: Sepucha
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D003151:Community Health Centers; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic