Barriers to and facilitators of sustaining a systemic lupus erythematosus (SLE) patient decision aid in regular rheumatology outpatient care in the USA.

Abstract

This study investigates the barriers to and facilitators of sustaining a decision aid (DA) tool for patients with SLE in routine rheumatology outpatient care across the USA. The DA was initially developed for assisting patients with SLE in making informed medication choices by providing personalized information on their treatment process. We conducted semi-structured interviews with clinicians, administrators, and information technology (IT) professionals from 15 geographically diverse rheumatology clinics that participated in a large-scale DA implementation trial. Interviews were transcribed and analysed using NVivo, with thematic coding to identify key factors influencing DA sustainability. The analysis identified several facilitators, including the DA's user-friendly design and its effectiveness in simplifying complex medical information, aiding informed decision-making for patients with SLE. Challenges affecting DA sustainability included inconsistent staff knowledge about the DA, difficulties integrating the DA into clinical workflows, a lack of executive and physician champions, and a lack of structured training and communication strategies. Additionally, concerns were raised about the availability of staff support and the technological capabilities required to maintain use of the DA. To sustain the DA in clinical practice, there is a need for enhanced training programs, better workflow integration, in-clinic physician champions, and effective use of electronic medical records for DA dissemination. Addressing these challenges would improve the impact of the DA on patient education and decision-making, ensuring its continued use in routine care. ClinicalTrials.gov, NCT03735238.