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- Title
Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters.
- Authors
Wyatt, Kirk D; Branda, Megan E; Anderson, Ryan T; Pencille, Laurie J; Montori, Victor M; Hess, Erik P; Ting, Henry H; Leblanc, Annie
- Abstract
<bold>Objective: </bold>To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes.<bold>Methods: </bold>Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions.<bold>Results: </bold>Of 339 encounters in the SDM intervention arm of the trials, 229 were video recorded and available for analysis. The mean proportion of fidelity items observed in each encounter was 58.4% (SD = 23.2). The proportion of fidelity items observed was significantly associated with patient knowledge (p = 0.01) and clinician involvement of the patient in decision making (p <0.0001), while no association was found with patient decisional conflict or satisfaction with the encounter.<bold>Conclusion: </bold>Clinicians' fidelity to usage instructions of point-of-care decision aids in randomized trials was suboptimal during their initial implementation in practice, which may have underestimated the potential efficacy of decision aids when used as intended.
- Publication
Implementation Science, 2014, Vol 9, Issue 1, p26
- ISSN
1748-5908
- Publication type
journal article
- DOI
10.1186/1748-5908-9-26