PMID- 23204075
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20121204
LR  - 20211021
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 2
IP  - 6
DP  - 2012
TI  - Why do clinicians not refer patients to online decision support tools? Interviews 
      with front line clinics in the NHS.
LID - 10.1136/bmjopen-2012-001530 [doi]
LID - e001530
AB  - OBJECTIVE: To assess whether clinical teams would direct patients to use 
      web-based patient decision support interventions (DESIs) and whether patients 
      would use them. DESIGN: Retrospective semistructured interviews and web server 
      log analysis. PARTICIPANTS AND SETTINGS: 57 NHS professionals (nurses, doctors 
      and others) in orthopaedic, antenatal, breast, urology clinics and in primary 
      care practices across 22 NHS sites given access to DESIs hosted on the NHS Direct 
      website. RESULTS: Fewer than expected patients were directed to use the web 
      tools. The most significant obstacles to referral to the tools were the attitudes 
      of clinicians and clinical teams. Technical problems contributed to the problems 
      but the low uptake was mainly explained by clinicians' limited understanding of 
      how patient DESIs could be helpful in clinical pathways, their perception that 
      'shared decision-making' was already commonplace and that, in their view, some 
      patients are resistant to being involved in treatment decisions. External 
      factors, such as efficiency targets and 'best practice' recommendations were also 
      cited being significant barriers. Clinicians did not feel the need to refer 
      patients to use decision support tools, web-based or not, and, as a result, felt 
      no requirement to change existing practice routines. Uptake is highest when 
      clinicians set expectations that these tools are integral to practice and embed 
      their use into clinical pathways. CONCLUSIONS: Existing evidence of patient 
      benefit and the free availability of patient DESIs via the web are not sufficient 
      drivers to achieve routine use. Health professionals were not motivated to refer 
      patients to these interventions. Clinicians will not use these interventions 
      simply because they are made available, despite good evidence of benefit to 
      patients. These attitudes are deep seated and will not be modified by solely 
      developing web-based interventions: a broader strategy will be required to embed 
      DESIs into routine practice.
FAU - Elwyn, Glyn
AU  - Elwyn G
AD  - Cochrane Institute of Primary Care and Public Health, Cardiff University, 
      Cardiff, UK.
FAU - Rix, Andrew
AU  - Rix A
FAU - Holt, Tom
AU  - Holt T
FAU - Jones, Deborah
AU  - Jones D
LA  - eng
PT  - Journal Article
DEP - 20121129
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
PMC - PMC3532981
EDAT- 2012/12/04 06:00
MHDA- 2012/12/04 06:01
PMCR- 2012/12/01
CRDT- 2012/12/04 06:00
PHST- 2012/12/04 06:00 [entrez]
PHST- 2012/12/04 06:00 [pubmed]
PHST- 2012/12/04 06:01 [medline]
PHST- 2012/12/01 00:00 [pmc-release]
AID - bmjopen-2012-001530 [pii]
AID - 10.1136/bmjopen-2012-001530 [doi]
PST - epublish
SO  - BMJ Open. 2012 Nov 29;2(6):e001530. doi: 10.1136/bmjopen-2012-001530. Print 2012.