Implementation Toolkit

Implementation of patient decision aids/decision support begins with

• wanting to be more patient-centred
• recognizing patients struggling with decision making
• needing to comply with new legislation
  • Washington State Legislature Health Care bill SB 5930 - 2007-08.
  • United States Government Patient Protection and Affordable Care Act. 2010.
• learning that decision aids help patients make higher quality decisions
• being called to reduce unwarranted practice variation

There are 5 Steps for implementing patient decision aids and decision support in health services. The following highlights the steps using a systems perspective and links to resources for each step. These steps are based on the Knowledge to Action Framework, Ottawa Model of Research Use, and several research studies.

Step 1: Identify the decision

Step 2: Find patient decision aids

Step 3: Identify barriers and explore ways to overcome them

Step 4: Implement decision aids/decision support with training

Step 5: Monitoring use and outcomes

Examples of additional resources

Archive of previous Implementation Toolkit - 2011 April

Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. (2006). Lost in knowledge translation: Time for a map? J Contin Educ Health Prof. 26(1):13-24.

Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. National Academy Press. Washington, DC.

Légaré F, Turcotte S, Stacey D, Ratté S, Kryworuchko J, Graham ID. (2012) Patients' perceptions of sharing in decisions: A systematic review of interventions to enhance shared decision making in routine clinical practice. Patient. 5(1):1-19. doi: 10.2165/11592180-000000000-00000.

Légaré F, Ratté S, Stacey D, Kryworuchko J, Gravel K, Graham ID, Turcotte S. (2010). Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. (5):CD006732.

Légaré F. (2005). Implementation of the Ottawa Decision Support Framework in five family practice teaching units: an exploratory trial. PhD dissertation, University of Ottawa. Ottawa, Canada.

Logan J, Harrison MB, Graham ID, Dunn K, Bissonnette J. (1999). Evidence-based pressure-ulcer practice: The Ottawa Model of Research Use. Can J Nurs Res. 31(1):37-52.

Murray MA, Stacey D, Wilson KG, O'Connor AM. (2010). Skills training to support patients considering place of end-of-life care: a randomized control trial. J Palliat Care. 26(2):112-21.

O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D. (2009). Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. (3):CD001431.

O'Connor AM, Wennberg JE, Legare F, Llewellyn-Thomas HA, Moulton BW, Sepucha KR, Sodano AG, King JS. (2007). Toward the 'tipping point': decision aids and informed patient choice. Health Aff (Millwood). 26(3):716-25.

Registered Nurses Association of Ontario (RNAO) (2006). Client Centred Care: Nursing Best Practice Guideline. Toronto, Canada: Registered Nurses Association of Ontario.

Stacey D, Higuchi KAS, Menard P, Davies B, Graham ID, O'Connor AM. (2009). Integrating patient decision support in an undergraduate nursing curriculum: An implementation project. Int J Nurs Educ Scholarsh. 6(1):Article10.

Stacey D, Chambers SK, Jacobsen MJ, Dunn J. (2008). Overcoming barriers to cancer helpline professionals providing decision support for callers: An implementation study. Oncol Nurs Forum. 35(6):961-9.

Stacey D, Pomey MP, O'Connor AM, Graham ID. (2006). Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing. Implementation Science, 1, 1-10.

Wennberg JE. (2002). Unwarranted variations in healthcare delivery: Implications for academic medical centres. BMJ. 325(7370):961-4.