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.
Acknowledgement
None.
Conflicts of interest
The authors have no conflict of interests.
Funding
This study was supported by grant RO1
HS013912 from the Agency for Healthcare
Research and Quality.
References
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
Task Force. American Journal of Preventive Medicine,
2004; 26: 56–66.
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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