Physicians as Part of the Solution? Community-Based Participatory Research as a Way to Get Shared Decision Making into Practice Stuart W. Grande Marie-Anne Durand Elliott S. Fisher Glyn Elwyn Email author Perspective First Online: 04 September 2013 Received: 13 February 2013 Revised: 02 July 2013 Accepted: 16 August 2013
ABSTRACT Although support among policy makers and academics for the wide scale adoption of shared decision making (SDM) is growing, actual implementation is slow, and faces many challenges. Extensive systemic barriers exist that prevent physicians from being able to champion SDM and lead practice change. In other areas of public health where implementation has been a challenge, community-based participatory research (CBPR) has effectively engaged resistant stakeholders to improve practice and the delivery of care. Might CBPR, defined broadly as research that engages participants in the conception, design, and implementation of relevant health programs, be a more effective way to engage physicians, patients, and managers in the implementation process? Consequently, we argue that adopting a participatory approach may help to overcome recognized barriers to progress in this area.
KEY WORDS shared decision making community-based participatory research implementation patient engagement clinical practice
REFERENCES 1.
Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–781.
PubMed CrossRef Google Scholar 2.
Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368(1):6–8.
PubMed CrossRef Google Scholar 3.
Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73(3):526–535.
PubMed CrossRef Google Scholar 4.
Elwyn G, Grande S, Gittel J, Godfrey M, Vidal D, eds. Are we there yet? Case studies of implementing decision support for patients. Hanover: Trustees of Dartmouth College; 2013:135.
Google Scholar 5.
Elwyn G, Scholl I, Mann M, et al. The implementation of patient decision support interventions into routine clinical practice: A systematic review. BMC Med Inform Decis. 2013;In Press.
Google Scholar 6.
Légaré F, Witteman HO. Shared decision making: Examining key elements and barriers to adoption into routine clinical practice. Health Affair. 2013;32(2):276–84.
CrossRef Google Scholar 7.
Collins ED, Moore CP, Clay KF, et al. Can women with early-stage breast cancer make an informed decision for mastectomy? J Clin Oncol. 2008;27(4):519–25.
PubMed CrossRef Google Scholar 8.
Arterburn D, Wellman R, Westbrook E, et al. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Affair. 2012;31(9):2094–2104.
CrossRef Google Scholar 9.
Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled “difficult” among key obstacles to shared decision making. Health Affair. 2012;31(5):1030–8.
CrossRef Google Scholar 10.
Faridi Z, Grunbaum JA, Gray BS, Franks A, Simoes E. Community-based participatory research: Necessary next steps. Prev Chronic Dis. 2007;4(3):A70.
Google Scholar 11.
Cook WK. Integrating research and action: A systematic review of community-based participatory research to address health disparities in environmental and occupational health in the USA. J Epidemio Commun H. 2008;62(8):668–76.
Google Scholar 12.
Israel BA, Coombe CM, Cheezum RR, et al. Community-based participatory research: A capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health. 2010;100(11):2094–102.
Google Scholar 13.
Minkler M, Blackwell AG, Thompson M, Tamir H. Community-based participatory research: Implications for public health funding. Am J Public Health. 2003;93(8):1210–3.
Google Scholar 14.
Minkler M, Thompson M, Bell J, Rose K. Contributions of community involvement to organizational-level empowerment: The federal healthy start experience. Health Educ Behav. 2001;28(6):783–807.
Google Scholar 15.
Elwyn G, Llyod A, Joseph-Williams N. Option Grids: Shared decision making made easier. Patient Educ Couns. 2013;90(2):207–212.
Google Scholar 16.
Montori VM, Breslin M, Maleska M, Weymiller AJ. Creating a conversation: Insights from the development of a decision aid. PLoS Med. 2007;4(8):e233.
Google Scholar 17.
Caldon LJM, Collins KA, Reed MW, et al. Clinicians’ concerns about decision support interventions for patients facing breast cancer surgery options: Understanding the challenge of implementing shared decision-making. Health Expect. 2011;14(2):133–46.
Google Scholar 18.
Grimshaw JM, Eccles MP, Walker AE, Thomas RE. Changing physicians’ behavior: What works and thoughts on getting more things to work. J Contin Educ Health Prof. 2002;22(4):237–43.
Google Scholar 19.
Parker EA, Israel BA, Robins TG, et al. Evaluation of Community Action Against Asthma: A community health worker intervention to improve children’s asthma-related health by reducing household environmental triggers for asthma. Health Educ Behav. 2008;35(3):376–95.
Google Scholar 20.
Jones L, Wells K. Strategies for academic and clinician engagement in community-participatory partnered research. J Am Med Assoc. 2007;297(4):407–10.
CrossRef Google Scholar 21.
Sandoval JA, Lucero J, Oetzel J, et al. Process and outcome constructs for evaluating community-based participatory research projects: A matrix of existing measures. Health Educ Res. 2011;27(4):680–90.
Google Scholar 22.
Seifer SD, Blanchard LW, Jordan C, Gelmon S, McGinley P. Faculty for the engaged campus: Advancing community-engaged careers in the academy. J High Educ Outreach Engagem. 2012;16(1):5–20.
Google Scholar 23.
McLaughlin K, Manns B, Mortis G, Hons R, Taub K. Why patients with ESRD do not select self-care dialysis as a treatment option. Am J Kidney Dis. 2003;41(2):380–5.
PubMed CrossRef Google Scholar 24.
Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. 2004;180(6 Suppl):S57–60.
PubMed Google Scholar 25.
Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity. Am J Public Health. 2010;100(Suppl):S40–6.
PubMed CrossRef Google Scholar 26.
Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: Assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.
Google Scholar © Society of General Internal Medicine 2013
Authors and Affiliations Stuart W. Grande Marie-Anne Durand Elliott S. Fisher Glyn Elwyn Email author 1. The Dartmouth Center for Health Care Delivery Science Dartmouth College Hanover USA 2. Department of Psychology University of Hertfordshire Hatfield UK 3. The Dartmouth Institute for Health Policy and Clinical Practice The Geisel School of Medicine at Dartmouth College Lebanon USA 4. The Cochrane Institute for Primary Care and Public Health Cardiff University Cardiff UK