title: Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making: Lessons from Two Specialties.
abstract: A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health's Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties.
  
  
  
  In-depth, qualitative interviews with specialty care providers in two specialties-orthopedics and cardiology-at two time points during DA implementation. Data were analyzed using a thematic analysis approach.
  
  
  
  We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years.
  
  
  
  Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias.
  
  
  
  Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.
authors.affiliation: Group Health Research Institute, Seattle, WA (CH, EOW, DA).
authors.forename: Clarissa
authors.initials: C
authors.lastname: Hsu
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL (DTL).
authors.forename: David T
authors.initials: DT
authors.lastname: Liss
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA (DLF).|Department of Medicine, University of California, Los Angeles, CA (DLF).
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.affiliation: Group Health Research Institute, Seattle, WA (CH, EOW, DA).
authors.forename: Emily O
authors.initials: EO
authors.lastname: Westbrook
authors.affiliation: Group Health Research Institute, Seattle, WA (CH, EOW, DA).
authors.forename: David
authors.initials: D
authors.lastname: Arterburn
mesh_terms: D001291:Attitude of Health Personnel; D002309:Cardiology; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009985:Orthopedics; D010358:Patient Participation / Q000379:methods* / Q000523:psychology*
keywords: decision aids; decision aids—tools; health service research; qualitative methods; shared decision making