Clinician Perceptions on Using Decision Tools to Support Prediction-Based Shared Decision Making for Lung Cancer Screening.
| Autor: | Skurla SE; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA., Leishman NJ; BioFire Diagnostics, LLC, Salt Lake City, UT, USA., Fagerlin A; University of Utah School of Medicine, Salt Lake City, UT, USA.; Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA., Wiener RS; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA.; The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Lowery J; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA., Caverly TJ; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA.; Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA.; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. |
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| Jazyk: | angličtina |
| Zdroj: | MDM policy & practice [MDM Policy Pract] 2024 May 20; Vol. 9 (1), pp. 23814683241252786. Date of Electronic Publication: 2024 May 20 (Print Publication: 2024). |
| DOI: | 10.1177/23814683241252786 |
| Abstrakt: | Background: Considering a patient's full risk factor profile can promote personalized shared decision making (SDM). One way to accomplish this is through encounter tools that incorporate prediction models, but little is known about clinicians' perceptions of the feasibility of using these tools in practice. We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS). Design: We conducted a qualitative study based on field notes from academic detailing visits during a multisite quality improvement program. The detailer engaged one-on-one with 96 primary care clinicians across multiple Veterans Affairs sites (7 medical centers and 6 outlying clinics) to get feedback on 1) the rationale for prediction-based LCS and 2) how to use the DecisionPrecision (DP) encounter tool with eligible patients to personalize LCS discussions. Results: Thematic content analysis from detailing visit data identified 6 categories of clinician willingness to use the DP tool to personalize SDM for LCS (adoption potential), varying from "Enthusiastic Potential Adopter" ( n = 18) to "Definite Non-Adopter" ( n = 16). Many clinicians ( n = 52) articulated how they found the concept of prediction-based SDM highly appealing. However, to varying degrees, nearly all clinicians identified challenges to incorporating such an approach in routine practice. Limitations: The results are based on the clinician's initial reactions rather than longitudinal experience. Conclusions: While many primary care clinicians saw real value in using prediction to personalize LCS decisions, more support is needed to overcome barriers to using encounter tools in practice. Based on these findings, we propose several strategies that may facilitate the adoption of prediction-based SDM in contexts such as LCS. Highlights: Encounter tools that incorporate prediction models promote personalized shared decision making (SDM), but little is known about clinicians' perceptions of the feasibility of using these tools in practice.We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS).While many clinicians found the concept of prediction-based SDM highly appealing, nearly all clinicians identified challenges to incorporating such an approach in routine practice.We propose several strategies to overcome adoption barriers and facilitate the use of prediction-based SDM in contexts such as LCS. Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors report grants from VA QUERI during the conduct of the study. Drs. Caverly and Lowery and Ms. Skurla reports grants from VA HSR&D during the conduct of the study. Dr. Wiener serves as deputy chief consultant for the VA National Center for Lung Cancer Screening. In addition, Dr. Caverly has a patent Apache 2.0 issued. (© The Author(s) 2024.) |
| Databáze: | MEDLINE |
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