Mullan mayo decision aids isdm09

Will this Decision Aid be Implemented? Rebecca Mullan Laurie J. Pencille, Lilisbeth Perestelo-Perez, Jane Linderbaum, Carrie Sanvick, Victor M. Montori, Henry Ting, and Carl May

% Months since incident MI Statins Beta blockers ACE-I/ARB Shah et al. Am J Med (In press)

Cardiologist - 70% do not believe it is ethical to give patients a choice about heart medications
Bedside Nurse - Not used to giving patients prognosis (risk of dying), concern about covering other patients.
Study coordinator - Can share only the clinical information that is on the decision aid.
Pharmacist - Not part of team or workflow
Nurse Practitioner – Fits within practice scope and skills
Who should deliver the DA?

Patients – yes Bedside nurse – yes Nurse Practitioner - yes Patients – yes Cardiologist - no Bedside nurse - yes Study coordinator - no Nurse Practitioner - yes What is the work of implementation? Are there resources? Do we have the skills? Are the tasks feasible? Can we work together on this? Patients – yes Nurse Practitioner - yes Patients – yes Bedside nurse – no Nurse Practitioner - yes What do I need to do to use the decision aid? Does it make sense to use a decision aid to do my job? How well was I able to use the decision aid? Do I understand the decision aid?

Normalization Process Theory What is the work of implementation? Are there resources? Do we have the skills? Are the tasks feasible? Can we work together on this? www.normalizationprocess.co.uk Carl R. May, PhD What do I need to do to use the decision aid? Does it make sense to use a decision aid to do my job? How well was I able to use the decision aid? Do I understand the decision aid?

What work is required to successfully implement the AMI decision aid? We are here Step 1 (Taxonomy Building) Pre-trial, identify potential work needed to deliver decision aid (workshop, nurse practitioner interviews). Step 2 (Process Evaluation) Create survey questions for clinicians and observational manual for study coordinators to collect data to test hypotheses derived from step 1 Step 3 (Analysis) Data analyses and verification with participants upon completion of the trial (workshops led by Carl May).

The Work Plan to Deliver Coordinate work with other nurses to avoid interruption Engage nurse management to ensure delivering the DA does not affect care of other patients Review the patient’s history and discuss with the physician Decision Aid Delivery Establish rapport and trust with the patient Assess patient’s readiness to participate Set expectation of what the patient is going to learn Engage family members when present Provide information and check for understanding, seek questions Assist in making the decision Explore patient’s motivation for decision and seek support (social work, pharmacy) as needed Post-Decision Notify the physician / document the patient’s decision

Normalization Process Analysis Are there resources? Do we have the skills? Are the tasks feasible? Can we work together on this? Observation manuals and participant questionnaires What do I need to do to use the decision aid? Does it make sense to use a decision aid to do my job? How well was I able to use the decision aid? Do I understand the decision aid?

Final thoughts
Decision aid trials offer an opportunity to study factors that would hinder or promote their implementation in practice.
Normalization Process Theory and analysis may be helpful in studying these factors.
Users will have evidence of efficacy and implementation.

Thanks!!
KER Unit Team
Division of Cardiology
SPARC innovation program
Patient advisory group

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Mullan mayo decision aids isdm09

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