title: Clinicians' perceptions of digital vs. paper-based decision support interventions.
abstract: OBJECTIVE
  Despite extensive evidence on the value of patient decision support interventions (DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach.
  
  
  RESULTS
  Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site.
  
  
  CONCLUSIONS
  Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption.
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Politi
authors.forename: Prajakta
authors.initials: P
authors.lastname: Adsul
authors.forename: Marie D
authors.initials: MD
authors.lastname: Kuzemchak
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeuner
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D001483:Base Sequence; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D008297:Male; D008511:Medicine; D008969:Molecular Sequence Data; D010358:Patient Participation / Q000379:methods*; D010465:Perception; D010820:Physicians; D036301:Qualitative Research; D020377:Self Efficacy; D012959:Socioeconomic Factors
keywords: behavioural science; decision aids; doctor-patient relationship; health communication; shared decision making