The Wiser Choices Program Diabetes Decision Aids

1

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
2

Statins
Beta blockers
ACE-I/ARB
Months since incident MI
Shah et al. Am J Med (In press)
3
Who should deliver the DA?

• 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

4
What is the work of implementation?
Patients yes Bedside nurse no Nurse
Practitioner - yes
Patients yes Cardiologist - no Bedside nurse -
yes Study coordinator - no Nurse Practitioner -
yes
Are there resources? Do we have the skills?
Patients yes Bedside nurse yes Nurse
Practitioner - yes
Are the tasks feasible? Can we work together on
this?
Patients yes Nurse Practitioner - yes
5
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?
Carl R. May, PhD
www.normalizationprocess.co.uk
6
What work is required to successfully implement
the AMI decision aid?
We are here
7
The Work
8
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
9
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.

10
Thanks!!

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