title: An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles.
abstract: Despite the proven efficacy of decision aids as interventions for increasing patient engagement and facilitating shared decision making, they are not used routinely in clinical care. Findings from a project designed to achieve such integration, conducted at five primary care practices in 2010-12, document low rates of distribution of decision aids to eligible patients due for colorectal cancer screening (9.3 percent) and experiencing back pain (10.7 percent). There were also no lasting increases in distribution rates in response to training sessions and other promotional activities for physicians and clinic staff. The results of focus groups, ethnographic field notes, and surveys suggest that major structural and cultural changes in health care practice and policy are necessary to achieve the levels of use of decision aids and shared decision making in routine practice envisioned in current policy. Among these changes are ongoing incentives for use, physician training, and a team-based practice model in which all care team members bear formal responsibility for the use of decision aids in routine primary care.
authors: Division of General Internal Medicine and Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, CA, USA.
authors: Grace A
authors: GA
authors: Lin
authors: Meghan
authors: M
authors: Halley
authors: Katharine A S
authors: KA
authors: Rendle
authors: Caroline
authors: C
authors: Tietbohl
authors: Suepattra G
authors: SG
authors: May
authors: Laurel
authors: L
authors: Trujillo
authors: Dominick L
authors: DL
authors: Frosch
mesh_terms: D001416:Back Pain / Q000175:diagnosis; D002140:California; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003625:Data Collection; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D017144:Focus Groups; D006801:Humans; D015279:Organizational Culture; D010353:Patient Education as Topic / Q000379:methods* / Q000458:organization & administration; D010358:Patient Participation / Q000379:methods*; D010820:Physicians