  Background: Shared decision-making (SDM) aims to empower patients to take an
active role in their treatment choices, supported by clinicians and patient
decision aids (PDAs). The purpose of this study is to explore barriers and
possible facilitators to SDM and a PDA in the prostate cancer trajectory. In
the process we identify possible actions that organizations and individuals can
take to support implementation in practice.
  Methods: We use the Ottawa Model of Research Use as a framework to determine
the barriers and facilitators to SDM and PDAs from the perspective of
clinicians. Semi-structured interviews were conducted with urologists (n=4),
radiation oncologists (n=3), and oncology nurses (n=2), focusing on the current
decision-making process experienced by these stakeholders. Questions included
their attitudes towards SDM and PDAs, barriers to implementation and possible
strategies to overcome them.
  Results: Time pressure and patient characteristics were cited as major
barriers by 55% of the clinicians we interviewed. Structural factors such as
external quotas for certain treatment procedures were also considered as
barriers by 44% of the clinicians. Facilitating factors involved organizational
changes to em-bed PDAs in the treatment trajectory, training in using PDAs as a
tool for SDM, and clinician motivation by disseminating positive clinical
outcomes. Our findings also suggest a role for external stakeholders such as
healthcare insurers in creating economic incentives to facilitate
implementation.
  Conclusion: Our findings highlight the importance of a multi-faceted
implementation strategy to support SDM. While clinician motivation and patient
activation are essential, structural/economic barriers may hamper
implementation. Action must also be taken at the administrative and policy
levels to foster a collaborative environment for SDM and, in the process, for
PDAs.
