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The following is a summary of “UPFRONT project: tailored implementation and evaluation of a patient decision aid to support shared decision-making about management of symptomatic uterine fibroids,” published in the November 2024 issue of Obstetrics & Gynecology by Forcino et al. 

Researchers conducted a retrospective study to evaluate the implementation of a patient decision aid for managing symptomatic uterine fibroids across 5 clinical settings in the US. 

They used a type 3 hybrid effectiveness-implementation stepped-wedge design with the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Clinician training and monthly reach tracking with feedback were implemented, along with patient and clinician surveys and visit audio recordings. Implementation strategies included assessing organizational readiness, synchronous clinician training, audit and feedback on decision aid reach, and providing multiple decision aid formats. Outcomes included patient-level reach, clinician-level adoption, and associations of decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with shared decision-making (collaboRATE and OPTION-5 measures). They also designed setting-level sustainability plans and assessed factors impacting sustained decision aid use. 

The results showed that 72 of 74 eligible gynecologists (97%) adopted the decision aid, reaching 2,553 patients. CollaboRATE scores improved among patients who received the decision aid (69% vs 59%; OR 1.6, 95% CI 1.16–2.27). Scores remained consistent in the intention-to-treat analysis (64% vs 63%; OR 0.86, 95% CI 0.61–1.22). Most participants preferred receiving the decision aid multiple times: 91.9% before, 90.7% during, and 86.5% after the visit. Shared decision-making did not improve when comparing pre-and post-implementation CollaboRATE scores (64% vs 63%; OR 0.86, 95% CI 0.61–1.22). 

They found that decision aids improved shared decision-making scores, but implementation challenges limited their impact. Future efforts should focus on better integration into clinical workflows and organizational incentives to prioritize shared decision-making. 

Source: implementationscience.biomedcentral.com/articles/10.1186/s13012-024-01404-5