Assignment: Organizational Level Barriers

Assignment: Organizational Level Barriers
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Assignment: Organizational Level Barriers
In conclusion, our study finds that a majority
of providers perceived that pre-clinic use of our
decision aid for CRC screening was a useful,
time-saving adjunct to their usual approach to
counselling about CRC screening and increased
the overall quality of decision making. Never-
theless, many of the providers felt that imple-
mentation of the decision aid into their practices
outside of the context of a clinical trial would be
challenging, thus highlighting the need for cost-
effective strategies for addressing provider,
practice and organizational level barriers to
routine use. We speculate that Internet-based
tools with enhanced navigation functionality
have the greatest dissemination potential, as
they offer a feasible, low-cost solution to many
of the structural barriers to implementation, as
well as a way to reconcile the diversity of opin-
ion related to content.
Conflicts of interest
The authors have no conflict of interests.
This study was supported by grant RO1
HS013912 from the Agency for Healthcare
Research and Quality.
1 Institute of Medicine. Crossing the Quality Chasm: A
New Health System for the 21st Century. Washington,
DC: National Academy Press, 2001.
2 Sheridan SL, Harris RP, Woolf SH. Shared decision
making about screening and chemoprevention. A
suggested approach from the U.S. Preventive Services
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3 Briss P, Rimer B, Reilley B et al. Promoting informed
decisions about cancer screening in communities and
healthcare systems. American Journal of Preventive
Medicine, 2004; 26: 67–80.
4 Charles C, Gafni A, Whelan T. Shared decision-
making in the medical encounter: what does it mean?
(or it takes at least two to tango). Social Science and
Medicine, 1997; 44: 681–692.
5 Charles C, Gafni A, Whelan T. Decision-making in
the physician-patient encounter: revisiting the shared
treatment decision-making model. Social Science and
Medicine, 1999; 49: 651–661.
6 Holmes-Rovner M, Valade D, Orlowski C, Draus C,
Nabozny-Valerio B, Keiser S. Implementing shared
decision-making in routine practice: barriers and
opportunities. Health Expectations, 2000; 3: 182–191.
7 Legare F, Ratte 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.
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