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01.12.2012 | Study protocol | Ausgabe 1/2012 Open Access

BMC Medical Informatics and Decision Making 1/2012

Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

BMC Medical Informatics and Decision Making > Ausgabe 1/2012
Anik Giguere, Michel Labrecque, Roland Grad, Michel Cauchon, Matthew Greenway, France Légaré, Pierre Pluye, Stephane Turcotte, Lisa Dolovich, R Brian Haynes
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6947-12-85) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contribution

AG conceived this study with BH, RG, PP, FL, ML, and ST. AG wrote the first draft and all authors critically revised the manuscript and approved its final version.



Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.


A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.


This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.
Additional file 1:Web-based questionnaire for clinicians on their perception of the Decision Boxes (Parts 1 and 3) and on their intention to use what they learned from the Decision Box to precisely explain the advantages and disadvantages of the options to their next patient to whom this intervention might apply (Part 2).(PDF 442 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
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