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Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative
Nicole Puccinelli-Ortega1, Mark Cromo2, Kristie L Foley1
1Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States.
Applied Clinical Informatics
|January 5, 2022
Summary
Implementing an iPad-based decision aid for colorectal cancer screening requires seamless clinic workflow integration. Addressing concerns about time, patient age, and literacy is crucial for successful adoption and sustainability of these tools.
Area of Science:
- Health Services Research
- Medical Informatics
- Patient Decision Making
Background:
- Informed decision aids enhance patient understanding and decision-making.
- An innovative iPad application was developed to support informed decisions about colorectal cancer screening.
Purpose of the Study:
- To explore the implementation of informed decision aids in primary care.
- Identify facilitators, barriers, and strategies for successful integration.
- Assess training needs and support for clinic staff.
Main Methods:
- A multicenter qualitative study was conducted in rural and urban primary care settings.
- Focus groups and semi-structured interviews were used with 48 participants (managers, clinicians, nurses, front desk staff).
- Thematic analysis guided data interpretation.
Main Results:
- Key themes included time constraints, workflow integration, patient age, literacy, and EHR integration.
- Clinic staff emphasized the importance of time savings and avoiding workflow disruptions.
- Concerns were raised regarding older patients' and low-literacy patients' ability to use the iPad application.
Conclusions:
- Successful long-term adoption of informed decision-making (IDM) apps depends on integration with minimal disruption to existing clinic workflows.
- Addressing patient-specific and system-level barriers is essential for sustainability.
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