Experts' views on the implementation of the prenatal screening decision aid in Iran: A qualitative study
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Abstract
Background & Aim: Patient decision aids are detailed and personalized health education materials that assist patients in decision making. According to expert viewpoints, this study aimed to determine important factors in implementing the prenatal screening decision aid in Iran.
Methods & Materials: In this qualitative study, 24 experts, including seven obstetricians, four information scientists, five managers or policymakers, and eight midwives, were selected using purposive and snowball sampling approaches. Semi-structured interviews were conducted to collect the data between January 2020 and June 2020 in Tehran, Iran. A prenatal screening decision aid was presented to the participants, and we asked them to raise their concerns and thoughts regarding the factors influencing the implementation of patient decision aids. We used MAXQDA 10 and applied conventional content analysis for data analysis.
Results: Two organizational and personal factors themes were identified to implement Iran's prenatal screening decision aids.
Conclusion: We identified the viewpoints of experts regarding major factors in patient decision aids implementation for prenatal screening. Before implementing prenatal screening decision aids in Iran, it would be helpful to consider these organizational and personal factors. Prenatal screening decision aids can provide better information for pregnant women and strengthen their decision-making ability.
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13. Munro S, Manski R, Donnelly K, Agusti D, Stevens G, Banach M, et al. Investigation of factors influencing the implementation of two shared decision making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. Implement Sci. 2019;14:95.
14. Berry DL, Hong F, Halpenny B, Sanda MG, Master VA, Filson ChP, et al. Evaluating clinical implementation approaches for prostate cancer decision support. Urol Pract. 2019; 6(2): 93-9.
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16. Stacey D, Taljaard M, Breau RH, Baba N, Blackmore T, Boland L, et al. A patient decision aid for men with localized prostate cancer. Cancer Nurs. 2018;1:E10-21.
17. MacDonald-Wilson KL. A successful implementation strategy to support adoption of decision making in mental health services. Community Ment Health. 2017; 53: 251–6.
18. Joseph-Williams N, Lloyd A, Edwards A, Stobbart L, Tomson D, Macphail Sh, et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ. 2017; 357: j1744.
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22. Abbasgholizadeh Rahimi S, Lépine J, Croteau J, Robitaille H, Giguere AM, Wilson BJ, Rousseau F, Lévesque I, Légaré F. Psychosocial Factors of Health Professionals' Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study. J Med Internet Res. 2018 Apr; 20 (4):e114. doi: 10.2196/jmir.9036.
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24. Lépine J, Leiva Portocarrero M, Delanoë A, Robitaille H, Lévesque I, Rousseau F, et al. What factors influence health professionals to use decision aids for Down syndrome prenatal screening? BMC Pregnancy Childbirth. 2016; 16: 262.
25. Savelberg W, Boersma LJ, Smidt M, Goossens MFJ, Hermanns R, van der Weijden T. Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. Eur J Oncol Nurs. 2019; 38:92-7.
26. Mangla M, Cha TD, Dorrwachter JM, Freiberg AA, Leavitt LJ, Rubash HE, et al. Increasing the use of patient decision AIDS in orthopaedic care: results of a quality improvement project. BMJ Qual Saf. 2018;27(5): 347–54.
27. Yu, C.H., Ke, C., Jovicic, A., Hall, S., Straus, S.E., Cantarutti, p., et al. Beyond pros and cons–developing a patient decision aid to cultivate dialog to build relationships: Insights from a qualitative study and decision aid development. BMC Med Inform Decis Mak. 2019; 19(1): 186. https://doi.org/10.1186/s12911-019-0898-5
28. Portocarrero ME, Giguere AM, Lepine J, Garvelink MM, Robitaille H, Delanoe A, et al. Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say? BMC Pregnancy Childbirth. 2017; 17(1): 1-9.
29. Jones J, Nowels C, Kutner JS, Matlock DD. Shared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives. Health Expect. 2015 Dec;18(6):3236-47. doi: 10.1111/hex.12313.
30. Belkora JK, Teng A, Volz S, Loth MK, Esserman LJ. Expanding the reach of decision and communication aids in a breast care center: a quality improvement study. Patient Educ Couns. 2011 May;83(2):234-9. doi: 10.1016/j.pec.2010.07.003.
31. Wilson BG. Reflections on constructivism and instructional design. Instructional development paradigms. Edited by: Dills CR, Romiszowski AJ. 1997, Englewood Cliffs: Educational Technology Publications, 63-80.
32. Pieterse AH, de Vries M, Kunneman M, Stiggelbout AM, Feldman-Stewart D. Theory-informed design of values clarification methods: A cognitive psychological perspective on patient health-related decision making. Soc Sci Med. 2013;77:156-63.
2. Adel A, Khodayari Zarnagh R, Darzi Ramandi S. Evaluating Clinical Governance in Patient and Society Participation. Journal of Health Picture. 2012 [Persian].
3. Höglund AT, Winblad U, Arnetz B, Arnetz JE. Patient participation during hospitalization for myocardial infarction: perceptions among patients and personnel. Scandinavian journal of caring sciences. 2010 Sep;24(3):482-9.
4. Alden DL, Friend J, Schapira M, Stiggelbout A. Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups. Social Science & Medicine. 2014 Mar 1;105:1-8.
5. Moca, D S. Should patient decision aids (PtDAs) be introduced in the health care system? Copenhagen: WHO Regional Office for Europe (Health Evidence Network). 2005.
6. Identify barriers and explore ways to overcome them. Available at: https://decisionaid.ohri.ca/strategies.html. Accessed April 7, 2021.
7. Zahedi R, Nemati-Anaraki L, Sedghi Sh, Shariat M. Factors Influencing Pregnant Women’s Use of Patient Decision Aids and Decision Making on Prenatal Screening: A Qualitative Study. J Fam Reprod Health 2020; 14(4): 231-8.
8. Allison T, Peter S, Jonathan C, Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups, International Journal for Quality in Health Care. 2007 Des; 19(6):349-57.
9. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004; 24(2): 105-12.
10. Guba EG, Lincoln YS. Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches: Jossey-Bass; 1981.
11. Joseph-Williams N, Abhyankar P, Boland L, Bravo P, Brenner AT, Brodney S, et al. What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration. Med Decis Making. 2020 Dec 15:272989X20978208. doi: 10.1177/0272989X20978208. Epub ahead of print. PMID: 33319621.0
12. Lin GA, Halley M, Rendle KAS, Tietbohl C, May SG, Trujillo L, et al. An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles. Health Aff. 2013; 32(2): 311-20.
13. Munro S, Manski R, Donnelly K, Agusti D, Stevens G, Banach M, et al. Investigation of factors influencing the implementation of two shared decision making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. Implement Sci. 2019;14:95.
14. Berry DL, Hong F, Halpenny B, Sanda MG, Master VA, Filson ChP, et al. Evaluating clinical implementation approaches for prostate cancer decision support. Urol Pract. 2019; 6(2): 93-9.
15. Dahl Steffensen K, Vinter M, Cruger D, Dankl K, Coulter A, Stuart B, et al. Lessons in integrating shared decision making into cancer care. J Oncol Pract. 2018;14(4): 229–35.
16. Stacey D, Taljaard M, Breau RH, Baba N, Blackmore T, Boland L, et al. A patient decision aid for men with localized prostate cancer. Cancer Nurs. 2018;1:E10-21.
17. MacDonald-Wilson KL. A successful implementation strategy to support adoption of decision making in mental health services. Community Ment Health. 2017; 53: 251–6.
18. Joseph-Williams N, Lloyd A, Edwards A, Stobbart L, Tomson D, Macphail Sh, et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ. 2017; 357: j1744.
19. Koon S. Important Considerations for Design and Implementation of Decision Aids for Shared Medical Decision Making. Perm J. 2020;24:19.064. doi: 10.7812/TPP/19.064.
20. Syrowatka A, Krömker D, Meguerditchian AN, Tamblyn R. Features of computer-based decision aids: Systematic review, thematic synthesis, and meta-analyses. J Med Internet Res. 2016 Jan 26; 18(1): e20. doi: 10.2196/jmir.4982.
21. Shorten A, Shorten B, Fagerlin A, Illuzzi J, Kennedy HP, Pettker C, Raju D, Whittemore R. A Study to Assess the Feasibility of Implementing a Web-Based Decision Aid for Birth after Cesarean to Increase Opportunities for Shared Decision Making in Ethnically Diverse Settings. J Midwifery Womens Health. 2019 Jan;64(1):78-87. doi: 10.1111/jmwh.12908.
22. Abbasgholizadeh Rahimi S, Lépine J, Croteau J, Robitaille H, Giguere AM, Wilson BJ, Rousseau F, Lévesque I, Légaré F. Psychosocial Factors of Health Professionals' Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study. J Med Internet Res. 2018 Apr; 20 (4):e114. doi: 10.2196/jmir.9036.
23. Stevens G, Thompson R, Watson B, Miller YD. Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities. Women Birth. 2016 Feb; 29(1):30-4. doi: 10.1016/j.wombi.2015.08.002.
24. Lépine J, Leiva Portocarrero M, Delanoë A, Robitaille H, Lévesque I, Rousseau F, et al. What factors influence health professionals to use decision aids for Down syndrome prenatal screening? BMC Pregnancy Childbirth. 2016; 16: 262.
25. Savelberg W, Boersma LJ, Smidt M, Goossens MFJ, Hermanns R, van der Weijden T. Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. Eur J Oncol Nurs. 2019; 38:92-7.
26. Mangla M, Cha TD, Dorrwachter JM, Freiberg AA, Leavitt LJ, Rubash HE, et al. Increasing the use of patient decision AIDS in orthopaedic care: results of a quality improvement project. BMJ Qual Saf. 2018;27(5): 347–54.
27. Yu, C.H., Ke, C., Jovicic, A., Hall, S., Straus, S.E., Cantarutti, p., et al. Beyond pros and cons–developing a patient decision aid to cultivate dialog to build relationships: Insights from a qualitative study and decision aid development. BMC Med Inform Decis Mak. 2019; 19(1): 186. https://doi.org/10.1186/s12911-019-0898-5
28. Portocarrero ME, Giguere AM, Lepine J, Garvelink MM, Robitaille H, Delanoe A, et al. Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say? BMC Pregnancy Childbirth. 2017; 17(1): 1-9.
29. Jones J, Nowels C, Kutner JS, Matlock DD. Shared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives. Health Expect. 2015 Dec;18(6):3236-47. doi: 10.1111/hex.12313.
30. Belkora JK, Teng A, Volz S, Loth MK, Esserman LJ. Expanding the reach of decision and communication aids in a breast care center: a quality improvement study. Patient Educ Couns. 2011 May;83(2):234-9. doi: 10.1016/j.pec.2010.07.003.
31. Wilson BG. Reflections on constructivism and instructional design. Instructional development paradigms. Edited by: Dills CR, Romiszowski AJ. 1997, Englewood Cliffs: Educational Technology Publications, 63-80.
32. Pieterse AH, de Vries M, Kunneman M, Stiggelbout AM, Feldman-Stewart D. Theory-informed design of values clarification methods: A cognitive psychological perspective on patient health-related decision making. Soc Sci Med. 2013;77:156-63.
| Files | ||
| Issue | Vol 9 No 1 (2022): Winter | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v9i1.7333 | |
| Keywords | ||
| decision making; decision support techniques; patient decision aid; prenatal diagnosis | ||
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How to Cite
1.
Zahedi R, Nemati-Anaraki L, Sedghi S, Shariat M. Experts’ views on the implementation of the prenatal screening decision aid in Iran: A qualitative study. NPT. 2021;9(1):62-70.
