J. Med. Internet Res. - Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff.

Tópicos

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Resumo

CKGROUND: Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening.OBJECTIVE: To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow.METHODS: Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter.RESULTS: All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients' lack of Internet access or low computer literacy, and potential impediments to the clinics' daily workflow. Expanding patients' use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients' screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients' screening preferences, though some expressed concern that such a system could be difficult to keep up and running.CONCLUSIONS: Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions.

Resumo Limpo

ckground inform lack capac work communiti practic set util health inform technolog colorect cancer screeningobject address gap ask work communiti practic set share perspect implement webbas patientl decis aid might affect patientclinician convers colorect cancer screen daytoday clinic workflowmethod five focus group five communiti practic set conduct physician physician assist clinic staff focus group organ use semistructur discuss guid design identifi factor mediat imped use webbas decis aid intend clarifi patient prefer colorect cancer screen trigger share decis make clinic encounterresult physician physician assist clinic staff activ particip focus group clinician staff particip set report belief webbas patientl decis aid inform educ tool one set particip report readi recommend tool patient except relat clinician one clinic describ prefer patient fewer screen choic note colonoscopi prefer screen modal patient clinic perceiv barrier util webbas decis aid includ patient lack internet access low comput literaci potenti impedi clinic daili workflow expand patient use onlin decis aid easi access understand util patient outsid offic visit describ potenti effici mean solicit patient screen prefer particip describ system link onlin decis aid computer remind system promot better understand patient screen prefer though express concern system difficult keep runningconclus communiti practic clinician staff perceiv webbas decis aid technolog promis rais question technolog result inform integr daili practic workflow addit research investig best implement onlin decis aid conduct prior widespread adopt technolog maxim benefit technolog minim workflow disrupt

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