Normalization of a conversation tool to promote shared decision making about anticoagulation in patients with atrial fibrillation within a practical randomized trial of its effectiveness: a cross-sectional study

Autor: Spencer-Bonilla, G., Thota, A., Organick, P., Ponce, O.J., Kunneman, M., Giblon, R., Branda, M.E., Sivly, A.L., Behnken, E., May, C.R., Montori, V.M., Montori, V., Brito, J.P., Hargraves, I., Fleming, K., Burnett, B., Linzer, M., Gorr, H., Jackson, E., Hess, E., Suzuki, T., Hamilton, J., Iv, Noseworthy, P.A., Haffke, A., Muegge, J., Poplau, S., Simpson, B., Vang, M., Wambua, M., Anderson, J., Bellolio, F., Cabalka, R., Ferrara, M., Inselman, J., Leblanc, A., Noseworthy, P., Olive, M., Shah, N., Stier, A., Ting, H., Vanmeter, D., Zeballos-Palacios, C., Nicollet-Healthpartners, P., Abullarde, C., Harvey, L., Keune, S., Smith, T., Stephens, S., Barksdale, B., Hickey, T., Peters, R., Price, M., Watson, C., Wolfe, D., Guyatt, G., Haynes, B., Tomlinson, G., Daniels, P., Gersh, B., Jaeger, T., McBane, R.
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Normalization process theory
Cross-sectional study
Medicine (miscellaneous)
Burnout
law.invention
0302 clinical medicine
Randomized controlled trial
law
Surveys and Questionnaires
Trial procedures
Medicine
Pharmacology (medical)
030212 general & internal medicine
Referral and Consultation
Shared decision making
media_common
Trials
lcsh:R5-920
030503 health policy & services
Communication
Middle Aged
Conversation aid
Female
0305 other medical science
lcsh:Medicine (General)
Normalization (statistics)
Adult
medicine.medical_specialty
media_common.quotation_subject
Health Personnel
Social Theory
Burnout
Psychological
Decision Support Techniques
03 medical and health sciences
Anticoagulation
Perception
Humans
Conversation
purl.org/pe-repo/ocde/ford#3.01.05 [https]
business.industry
Research
Anticoagulants
Atrial fibrillation
Clinical trial
Cross-Sectional Studies
Family medicine
Patient Participation
business
Decision Making
Shared
Zdroj: Trials, Vol 21, Iss 1, Pp 1-10 (2020)
Trials
Trials, 21(1). BMC
ISSN: 1745-6215
Popis: Background Shared decision making (SDM) implementation remains challenging. The factors that promote or hinder implementation of SDM tools for use during the consultation, including contextual factors such as clinician burnout and organizational support, remain unclear. We explored these factors in the context of a practical multicenter randomized trial evaluating the effectiveness of an SDM conversation tool for patients with atrial fibrillation considering anticoagulation therapy. Methods In this cross-sectional study, we recruited clinicians who were regularly involved in conversations with patients regarding anticoagulation for atrial fibrillation. Clinicians reported their characteristics and burnout symptoms using the two-item Maslach Burnout Inventory. Clinicians were trained in using the SDM tool, and they recorded their perceptions of the tool’s normalization potential using the Normalization MeAsure Development (NoMAD) survey instrument and verbally reflected on their answers to these survey questions. When possible, the training sessions and clinicians’ verbal responses to the conversation tool were recorded. Results Our study comprised 183 clinicians recruited into the trial (168 with survey responses and 112 with recordings). Overall, clinicians gave high scores to the normalization potential of the intervention; they endorsed all domains of normalization to the same extent, regardless of site, clinician characteristics, or burnout ratings. In interviews, clinicians paid significant attention to making sense of the tool. Tool buy-in seemed to depend heavily on their ability to see the tool as accurate and “evidence-based” and their perceptions of having time in the consultation to use it. Conclusions While time in the consultation remains a barrier, we did not find a significant association between burnout symptoms and normalization of an SDM conversation tool. Possible areas for improving the normalization of SDM conversation tools in clinical practice include enabling collaboration among clinicians to implement the tool and reporting how clinicians elsewhere use the tool. Direct measures of normalization (i.e., observing how often clinicians access the tool in practice outside of the clinical trial) may further elucidate the role that contextual factors, such as clinician burnout, play in the implementation of SDM. Trial registration ClinicalTrials.gov, NCT02905032. Registered on 9 September 2016.
Databáze: OpenAIRE
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