title: Implementation of a cystic fibrosis lung transplant referral patient decision aid in routine clinical practice: an observational study.
abstract: BACKGROUND
  The decision to have lung transplantation as treatment for end-stage lung disease from cystic fibrosis (CF) has benefits and serious risks. Although patient decision aids are effective interventions for helping patients reach a quality decision, little is known about implementing them in clinical practice. Our study evaluated a sustainable approach for implementing a patient decision aid for adults with CF considering referral for lung transplantation.
  
  
  METHODS
  A prospective pragmatic observational study was guided by the Knowledge-to-Action Framework. Healthcare professionals in all 23 Canadian CF clinics were eligible. We surveyed participants regarding perceived barriers and facilitators to patient decision aid use. Interventions tailored to address modifiable identified barriers included training, access to decision aids, and conference calls. The primary outcome was >80% use of the decision aid in year 2.
  
  
  RESULTS
  Of 23 adult CF clinics, 18 participated (78.2%) and 13 had healthcare professionals attend training. Baseline barriers were healthcare professionals' inadequate knowledge for supporting patients making decisions (55%), clarifying patients' values for outcomes of options (58%), and helping patients handle conflicting views of others (71%). Other barriers were lack of time (52%) and needing to change how transplantation is discussed (42%). Baseline facilitators were healthcare professionals feeling comfortable discussing bad transplantation outcomes (74%), agreeing the decision aid would be easy to experiment with (71%) and use in the CF clinic (87%), and agreeing that using the decision aid would not require reorganization of the CF clinic (90%). After implementing the decision aid with interventions tailored to the barriers, decision aid use increased from 29% at baseline to 85% during year 1 and 92% in year 2 (p < 0.001). Compared to baseline, more healthcare professionals at the end of the study were confident in supporting decision-making (p = 0.03) but continued to feel inadequate ability with supporting patients to handle conflicting views (p = 0.01).
  
  
  CONCLUSIONS
  Most Canadian CF clinics agreed to participate in the study. Interventions were used to target identified modifiable barriers to using the patient decision aid in routine CF clinical practice. CF clinics reported using it with almost all patients in the second year.
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Vandemheen
authors.forename: Rosamund
authors.initials: R
authors.lastname: Hennessey
authors.forename: Tracy
authors.initials: T
authors.lastname: Gooyers
authors.forename: Ena
authors.initials: E
authors.lastname: Gaudet
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Mallick
authors.forename: Josette
authors.initials: J
authors.lastname: Salgado
authors.forename: Andreas
authors.initials: A
authors.lastname: Freitag
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthiaume
authors.forename: Neil
authors.initials: N
authors.lastname: Brown
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D003550:Cystic Fibrosis / Q000601:surgery*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007318:Inservice Training; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010358:Patient Participation / Q000379:methods*; D010595:Pharmacists; D010820:Physicians; D011446:Prospective Studies; D013997:Time Factors