Table 2 Facilitators and barriers to P3P implementation
From: Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study
TICD determinant domains | Perceived facilitators | Perceived barriers |
|---|---|---|
Guideline factors | • Simplified process for implementation • P3P serves as an “on-ramp” to PRO surveys | • Provider skepticism regarding SDM • Provider skepticism regarding P3P |
Patient factors | • Enhances patient experience • Helps to glean information from patients • Objectively captures patient views • MUSIC provided tablet computers to bridge the gap in access | • Added burden on patients • Patients perceiving P3P questions to be intrusive • Patient access to email, internet and computers |
Individual provider factors | • Helps urologists have treatment discussions • Incorporates patient input in decision-making | • Perception that P3P could go against urologists preferred workflow • P3P vs. other tools (AUA-SI, or IPSS-SF) |
Provider interactions | • Teamwork-coordination between urologists, mid-level providers and coordinators, navigators • Creating internal notification • Coordination with MUSIC staff | • Incoming referrals for treatment (patients seen by different urologists so opportunity to complete P3P is absent) |
Capacity for organizational change | • Clinical champions • Dedicated staff assigned to facilitate P3P implementation • Electronic Health Record integration (alerts, reminders and EHR smart phrases for physician orders) | • Organizational factors such as organizational buy-in, IRB issues • Staffing—turnovers and capacity • Competing priorities • Fear of change or fear of forgetting |