Background: Moving interventions (i.e., new knowledge, tools, and technologies) into clinical practice are often lengthy and challenging processes, even when they are strongly supported by research evidence. Conversely, organizations and providers sometimes adopt interventions in the absence of strong research evidence. Understanding decision-making around the adoption of new interventions is paramount to developing more effective strategies to facilitate the use of evidence-based interventions in practice. Aim: To illuminate the decision-making processes involved in the adoption of patient-centered interventions by cancer care teams, including how research evidence is considered, and identify additional factors influencing these decisions. We focused on two interventions (survivorship care plans [SCPs] and patient decision aids [PtDAs]) due to their differing levels of research evidence and real-world adoption: SCPs = low evidence; high adoption; PtDAs = high evidence; low adoption. Methods: Guided by the principles of grounded theory, we conducted semistructured interviews with clinicians, managers, and administrators of cancer care programs across Canada (n=21). Data were collected and analyzed concurrently, using a constant comparative approach. Data collection ended upon reaching theoretical saturation. Results: Participants emphasized that high-quality research evidence is often unnecessary when making adoption decisions around interventions that are intuitively “good ideas.” Six key factors contributed to adoption/nonadoption decisions around SCPs and PtDAs: 1) alignment (or misalignment) of research evidence with clinical experiences, patient experiences/preferences, and local data; 2) perceived benefit to clinicians themselves; 3) endorsement by respected organizations; 4) existence of local champions; 5) ability to adapt the intervention to local contexts; and 6) ability to routinize the intervention across a large patient population. Conclusion: Many factors influence decisions to adopt patient-centered interventions, including clinicians' experiences and perceived benefits, the existence of organizational and extraorganizational advocates, and ease/reach of implementation.
Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan
