Time required to implement a computerized patient decision aid for lupus in outpatient visits

Patient decision aids have the potential to lower decision conflict for patients and to improve patient-physician communication. However, uptake of decision aids has been poor, in part because the time required to incorporate these into clinical practice is not well understood.

To estimate the time required for a rheumatology clinic to implement a validated decision aid for patients with lupus.

Using a cohort of eight implementation sites, study investigators identified the activities required to administer a decision aid. Site coordinators embedded within the clinics timed the duration of each activity. To estimate the effect of viewing the decision aid on the length of the physician-patient interaction, patient visits were timed and the length of visits for patients who viewed the decision aid were compared with visit lengths for three groups of control patients.

Estimates of the effect of the decision aid on patient visit lengths ranged from a reduction of 3 min per visit to an increase of 3.88 min per visit, with five out of six estimates suggesting the decision aid is associated with shorter patient visits. Introducing the decision aid to patients took a mean of 4.12 min (median of 2 min). Identifying patients eligible for the decision aid was a weekly or bi-weekly process for most clinics and took an average of 41.43 min.

The time required for a rheumatology clinic to implement the decision aid for patients with lupus is low. Our results raise questions about why decision aid take up is low among clinical practices, given the benefits the lupus decision aid offers to patients (reduced decisional conflict and better-informed choice of immunosuppressive medications used for the treatment of lupus kidney disease). More research is needed to identify barriers to decision aid adoption.