Evidence map›Paper›PMID 39501337›Full record

Trial reportImplementation science : IS2024

The UPFRONT project: tailored implementation and evaluation of a patient decision aid to support shared decision-making about management of symptomatic uterine fibroids.

Rachel C Forcino, Marie-Anne Durand, Danielle Schubbe, Jaclyn Engel, Erika Banks, Shannon K Laughlin-Tommaso, Tina Foster, Tessa Madden, Raymond M Anchan, Mary Politi and 10 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03985449 (Implementation of Uterine Fibroid Option Grid Patient Decision Aids Across Five Organizational Settings), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03985449 nacompletednot on this map

Implementation of Uterine Fibroid Option Grid Patient Decision Aids Across Five Organizational Settings: a Randomized Stepped-wedge Study

TypeinterventionalSponsorDartmouth-Hitchcock Medical CenterRan2019 to 2023Enrolled748ConditionsUterine FibroidArmsUterine Fibroid Option Grid encounter patient decision aid (text only), Uterine Fibroid Option Grid encounter patient decision aid (text + Pictures), Uterine Fibroid Option Grid encounter patient decision aid (online)
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Rachel C ForcinoDepartment of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA. rforcino@kumc.edu.
Marie-Anne DurandThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Danielle SchubbeThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Jaclyn EngelThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Erika BanksDepartment of Obstetrics and Gynecology, NYU Langone Long Island, Mineola, NY, USA.
Shannon K Laughlin-TommasoDepartment of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Tina FosterDepartment of Obstetrics and Gynecology, Dartmouth-Hitchcock Health, Lebanon, NH, USA.
Tessa MaddenDepartment of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
Raymond M AnchanDepartment of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mary PolitiDepartment of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
Anne LindholmDepartment of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Rossella M GargiuloDepartment of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Maya SeshanDepartment of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Marisa TomainoRutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA.
Jingyi ZhangThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Stephanie C AcquilanoThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Sade AkinfeThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Anupam SharmaThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
Johanna W M AartsAmsterdam UMC, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands.
Glyn ElwynThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States.

methodsWe used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use.

resultsThe decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16-2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22).

conclusionWhen patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making.

trial registrationClinicalTrials.gov NCT03985449; registered 6 June 2019.

Indexed as

Decision Making, SharedDecision Support TechniquesLeiomyomaPatient ParticipationAdultFemaleHumansImplementation ScienceMiddle AgedUnited StatesUterine NeoplasmsConversation aidImplementation sciencePatient decision aidShared decision making trainingSymptomatic uterine fibroids

Identifiers

PMID39501337
PMCPMC11536971

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.