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Implement Sci. 2014 Feb 22;9:26. doi: 10.1186/1748-5908-9-26.

Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters.

Author information

1
Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First St, SW, Rochester, MN, USA. LeBlanc.Annie@mayo.edu.

Abstract

OBJECTIVE:

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.

METHODS:

Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions.

RESULTS:

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.

CONCLUSION:

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.

PMID:
24559190
PMCID:
PMC3936841
DOI:
10.1186/1748-5908-9-26
[Indexed for MEDLINE]
Free PMC Article

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