Background: Shared decision-making is needed between consumers and clinicians to ensure care is ‘valuable’ and meaningfully improves peoples’ lives. Patient Decision Aids (PDAs) are clinical tools that support shared decision-making through: 1) stating the decision that needs to be made and appropriate options available; 2) discussing the potential benefits, harms and unknowns of each option; and 3) clarifying congruence between options and patients’ personal values. Evidence demonstrates PDAs lead to benefits for patients and carers however, widespread adoption has not occurred due to challenges in implementation.

 

Aim: To explore barriers, enablers and implementation of a generic PDA for use at the EOL.

 

Methods: Semi-structured interviews were conducted with multidisciplinary clinicians and consumers from various contexts across Queensland. Interviews were transcribed and analysed using grounded theory and interpreted in the context of the COM-B Framework and Behaviour Change Wheel.

 

Results: 17 clinicians (medical, nursing, allied health), and 15 consumers (patients and carers) from metropolitan, regional, and rural areas participated in a single confidential interview. Challenges identified included power imbalances in healthcare, and the need to tailor a PDA intervention to varying: 1) clinical scenarios (sudden and progressive decline); 2) levels of health literacy; and 3) desire to participate in shared decision-making. Respondents felt the PDA was best implemented within a bundled approach (clinical tools, education, support and resources) with emphasis on clinicians and consumers being empowered to draw upon the core principles of shared decision-making in any context. A range of practical approaches were identified to increase capability, opportunity, and motivation of clinicians and consumers to engage in shared decision-making.

 

Conclusion: Successful implementation of the generic PDA at the EOL is believed to be dependent on underpinning the clinical tool within a broader framework of shared decision-making to enable behavioural and cultural change.