--- title: "Review: implementation pt dec spt interventions | Sutter Health" description: "Need to understand more the professional and organizational resistance to decision aids, e.g., lack of incentives to use these interventions." url: "https://www.sutterhealth.org/research/publications/review-implementation-pt-dec-spt-interventions-1055312535" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Review: implementation pt dec spt interventions # "Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice. Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AG, Clay C, Légaré F, van der Weijden T, Lewis CL, Wexler RM, & Frosch DL. _BMC Med Inform Decis Mak. 13(suppl 2):S14. doi: 10.1186/1472-6947-13-S2-S14. Epub 2013 Nov 29._ 2013-01-01 ## Abstract BACKGROUND: Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. METHODS: An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. RESULTS: After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. CONCLUSIONS: It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the 'barriers' and 'facilitators' approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/24625083) ## Research topics - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Patient and family engagement: a survey of US hospital practices.](https://www.sutterhealth.org/research/publications/pt-family-engagement-survey-us-hosp-practices-1055312463) Herrin J, Harris KG, Kenward K, Hines S, Joshi MS, Frosch DL. BMJ Qual Saf. pii: bmjqs-2015-004006. doi: 10.1136/bmjqs-2015-004006. \[Epub ahead of print\] 2015 Jun 16 - Publication ### [Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems.](https://www.sutterhealth.org/research/publications/shared-decision-making-motivational-interviewing-1055312537) Elwyn G, Dehlendorf C, Epstein RM, Marrin K, White J, Frosch DL. Ann Fam Med. 12(3):270-5. doi: 10.1370/afm.1615. 2014 May 01 - Publication ### [Collaborative deliberation: a model for patient care.](https://www.sutterhealth.org/research/publications/collaborative-deliberation-pt-care-model-1055312489) Elwyn G, Lloyd A, May C, van der Weijden T, Stiggelbout A, Edwards A, Frosch DL, Rapley T, Barr P, Walsh T, Grande SW, Montori V, Epstein R. Patient Educ Couns. 97(2):158-64. doi: 10.1016/j.pec.2014.07.027. Epub 2014 Aug 13. 2014 Nov 01 - Publication ### [Communicating with physicians about medical decisions: a reluctance to disagree.](https://www.sutterhealth.org/research/publications/comm-with-mds-re-med-decs-reluctant-to-disagree-1055312531) Adams JR, Elwyn G, Légaré F, Frosch DL. Arch Intern Med. 2012 Aug 13;172(15):1184-6. doi: 10.1001/archinternmed.2012.2360. 2012 Aug 13 - Publication ### [An exploratory mixed-methods crossover study comparing DVD- vs. Web-based patient decision support in three conditions: The importance of patient perspectives.](https://www.sutterhealth.org/research/publications/dvd-vs-web-based-pt-decision-spt-1055312529) Halley MC, Rendle KA, Gillespie KA, Stanley KM, Frosch DL. Health Expect. 18(6):2880-91. doi: 10.1111/hex.12273. Epub 2014 Sep 29. 2015 Dec 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/review-implementation-pt-dec-spt-interventions-1055312535#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Review: implementation pt dec spt interventions"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/review-implementation-pt-dec-spt-interventions-1055312535#medicalscholarlyarticle","name":"\"Many miles to go …\": a systematic review of the implementation of patient decision support interventions into routine clinical practice.","headline":"Review: implementation pt dec spt interventions","abstract":"BACKGROUND: Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. METHODS: An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. RESULTS: After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. CONCLUSIONS: It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the 'barriers' and 'facilitators' approach to understand more about the nature of professional and organizational resistance to these tools. 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