title: Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff.
abstract: BACKGROUND
  Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening.
  
  
  OBJECTIVE
  To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow.
  
  
  METHODS
  Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter.
  
  
  RESULTS
  All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients' lack of Internet access or low computer literacy, and potential impediments to the clinics' daily workflow. Expanding patients' use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients' screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients' screening preferences, though some expressed concern that such a system could be difficult to keep up and running.
  
  
  CONCLUSIONS
  Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions.
authors.affiliation: University of Michigan, Departments of Family Medicine and Urology, Ann Arbor, MI, United States. mjimbo@umich.edu.
authors.forename: Masahito
authors.initials: M
authors.lastname: Jimbo
authors.forename: Cameron Garth
authors.initials: CG
authors.lastname: Shultz
authors.forename: Donald Eugene
authors.initials: DE
authors.lastname: Nease
authors.forename: Michael Derwin
authors.initials: MD
authors.lastname: Fetters
authors.forename: Debra
authors.initials: D
authors.lastname: Power
authors.forename: Mack Thomas
authors.initials: MT
authors.lastname: Ruffin
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003151:Community Health Centers; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D017144:Focus Groups; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D010358:Patient Participation; D011320:Primary Health Care; D017216:Telemedicine
keywords: cancer screening; colon cancer; colonoscopy; decision support techniques; early detection of cancer; focus groups; health information technology; reminder systems