Evaluation of Implementation Outcomes After Initiation of a Shared Decision-making Program for Men With Prostate...

Area of Science:

• Health Informatics
• Patient Decision Making
• Prostate Cancer Management

Background:

• Electronic patient decision aids (PDAs) integrated into electronic medical records (EMRs) have the potential to improve patient engagement.
• Implementation of PDAs within EMR systems presents unique challenges that require careful evaluation.

Purpose of the Study:

• To assess the barriers to implementing PDAs within an EMR system.
• To determine the penetration and fidelity of PDA use among eligible patients.
• To evaluate the impact of PDA use on patient-centered decision-making outcomes.

Main Methods:

• A prospective implementation outcomes analysis was conducted with men diagnosed with incident localized prostate cancer.
• Eligibility for PDAs was determined through EMR review, with retrospective chart review used to identify missed patients and miscategorization causes.
• Patient-centered outcomes were analyzed comparing those who received the PDA versus those who did not.

Main Results:

• PDA completion fidelity was 84% (314/374 men).
• Initial prospective PDA penetration assessment was 100%, but retrospective review revealed 20% penetration, highlighting algorithm limitations.
• PDA completion correlated with reduced decisional conflict and increased perceived shared decision-making (P<.03).

Conclusions:

• This study identified modifiable system and EMR-related factors hindering PDA penetration.
• Improvements to the EMR-based identification algorithm are necessary for broader PDA implementation.
• The implemented PDA demonstrated benefits in decisional quality for prostate cancer patients.