title: Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation.
abstract: BACKGROUND
  Despite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented.
  
  
  OBJECTIVE
  To explore nurses' experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation.
  
  
  METHODS
  This investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.
  
  
  RESULTS
  Three themes and nine sub-themes emerged: (1) "Choice as facilitator for shared understanding and engagement in patients' own care," with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) "enhancing the patients' strengths," with two sub-themes: releasing patient's internal strengths and confirming "normalcy" for the patient; and (3) "new challenges for the nurse," with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges.
  
  
  CONCLUSIONS
  Findings suggest that, from nurses' perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses' professional roles and created dilemmas such as nurses' ambivalence regarding patients' levels of disclosure of sensitive issues and the nurses' ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.
authors.affiliation: Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway. Electronic address: Elin.borosund@rr-research.no.
authors.forename: Elin
authors.initials: E
authors.lastname: Børøsund
authors.affiliation: Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway; Department of Medicine, University of Oslo, Norway.
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Ruland
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: Moore
authors.affiliation: Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway; School of Technology and Health, KTH, Royal Institute of Technology, Stockholm, Sweden.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Ekstedt
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003142:Communication; D006284:Health Plan Implementation; D006801:Humans; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D018802:Patient-Centered Care; D013813:Therapy, Computer-Assisted; D013997:Time Factors
keywords: Cancer care; Focus groups; Implementation; Nurses experiences; Patient-centered care; Patient–provider communication; Tailored symptom assessment