title: Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study.
abstract: BACKGROUND
  Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice.
  
  
  METHODS
  We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information.
  
  
  RESULTS
  One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6±1.2, scale 1-7, with 7 being "high"), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P<0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear "bottom line" statement for each Dbox and access to printed Dboxes in consultation rooms.
  
  
  CONCLUSIONS
  Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.
authors.forename: Anik M C
authors.initials: AM
authors.lastname: Giguere
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
authors.forename: Roland
authors.initials: R
authors.lastname: Grad
authors.forename: Pierre
authors.initials: P
authors.lastname: Pluye
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Michel
authors.initials: M
authors.lastname: Cauchon
authors.forename: Matthew
authors.initials: M
authors.lastname: Greenway
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Carmichael
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D004502:Education, Medical, Continuing / Q000379:methods; D004506:Education, Nursing / Q000379:methods; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education / Q000379:methods*; D005260:Female; D006801:Humans; D033182:Intention; D007396:Internship and Residency / Q000379:methods; D008297:Male; D009732:Nursing Care / Q000379:methods*; D009864:Ontario; D010358:Patient Participation / Q000379:methods*; D018802:Patient-Centered Care; D010549:Personal Satisfaction; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000706:statistics & numerical data; D057170:Translational Research, Biomedical