Using Nudges to Enhance Clinicians' Implementation of Shared Decision Making With Patient Decision Aids.

Area of Science:

• Implementation Science
• Behavioral Economics
• Health Services Research

Background:

• Effective shared decision-making (SDM) interventions are underutilized in clinical practice.
• Behavioral economics 'nudges' can influence population behavior but haven't been applied to SDM.
• Clinician motivation is a key barrier to adopting SDM tools.

Purpose of the Study:

• To evaluate the MINDSPACE behavioral economics framework's impact on clinician motivation during decision aid (DA) implementation.
• To describe how MINDSPACE was operationalized across nine hospitals for a left ventricular assist device DA.
• To propose recommendations for applying behavioral economics in implementation science.

Main Methods:

• Qualitative thematic analysis of stakeholder meeting notes from a 6-month DA implementation.
• Quantitative evaluation of implementation progress using the RE-AIM framework.
• Application of the MINDSPACE framework to influence clinician behavior and motivation.

Main Results:

• MINDSPACE strategies fostered stakeholder engagement, ownership, positive associations, and norm-spreading.
• Decision aid (DA) reach to eligible patients increased from 9.8% to 70.0% within six months.
• Significant gains in DA reach correlated with MINDSPACE-informed meetings.

Conclusions:

• Behavioral economics principles, like MINDSPACE, can enhance clinician motivation and drive SDM tool uptake.
• The study provides practical recommendations for applying behavioral economics in real-world implementation science.
• This approach is valuable in settings with limited resources for organizational change.