Login to Access Video or Poster Abstract: MP69-18
Sources of Funding: NIH 5R01NR009692

Introduction

Implementation of evidenced-based patient-centered care is challenging in clinical settings. Success of such practice changes varies. The purpose of our study was to evaluate implementation strategies to deploy a shared decision aid for localized prostate cancer (LPC).

Methods

The Personal Patient Profile-Prostate (P3P) is a web-based decision aid with demonstrated efficacy in reducing decisional conflict among men choosing a care plan for LPC. Implementation strategies were co-designed with leaders in six geographically-diverse urology clinics. As part of routine care, men were informed of P3P and offered access via a variety of methods. Physicians received 1-page summaries of P3P patient-generated reports of current symptoms and factors influencing the care decision. Focus groups including physicians, clinic staff and administrators were held at each site to solicit feedback after the implementation period. Access metrics were monitored for up to 6 months. General impressions, common barriers and promoters were identified and synthesized from the focus group data.

Results

Two sites chose written information only to inform men of P3P, 1 site chose email only, 1 site chose email plus phone contact, 1 site chose MD instruction to use, followed by phone and email follow up and 1 site chose in clinic only. Barriers common to all settings included creating new workflows on top of heavy workloads, and staff and administrator misunderstanding of P3P context and resources. Staff inability to identify men with new LPC (vs follow up visits) hampered access. Promoters to successful implementation included an identified clinical lead, physician engagement and phone combined with email contact. Of all men with LPC seen in the clinics, 51% (range 15-98%) were informed of P3P. The highest rates of P3P access outside of clinic and prior to the consult visit (82, 73%) were observed when 2-3 modes of informing were implemented: physician, email and phone invitations. Clinic sites that chose to only provide written material with instruction to access P3P had the lowest access rates (range 0-14%). Physicians appraised the summaries as useful and helpful.

Conclusions

Despite challenges for clinic staff to add strategies to implement P3P to already heavy workloads, success was realized when physicians engaged and when staff provided follow up contacts to encourage P3P access. New practice changes to implement an evidence-based intervention require multi-modal strategies for early success. Future trials evaluating methods to reduce clinical workload may be of value.

Funding

NIH 5R01NR009692