We will use a multi-component, shared decision-making (SDM) implementation strategy.
The strategy will be guided by the Consolidated Framework for Implementation Research (CFIR) and the Normalization Process Theory (NPT).
The SDM strategy will include four components:
assessment of organizational readiness for SDM and the generation of a tailored strategy at each site to address potential organizational barriers to implementation
online or in-person initiation training of participating clinical teams
implementation of a paper-based text or picture version and a web-based Option Grid encounter decision aid
where possible, integration of new evidence and the SDM approach into existing clinical practice guidelines
Participating project sites and inclusion criteria
Dartmouth-Hitchcock Medical Center | Lebanon, NH
Washington University/Barnes-Jewish Hospital | St. Louis, MO
Montefiore Medical Center | Bronx, NY
Brigham & Women's Hospital | Boston, MA
Mayo Clinic | Rochester, MN
Patient participant inclusion criteria:
We will include patients showing new or recurrent symptoms of uterine fibroids (e.g. heavy menstrual bleeding, pelvic pressure or pain, etc.) who are seeking treatment and who meet the following inclusion criteria: (1) assigned female sex at birth, (2) at least 18 years of age, (3) spoken English or Spanish, (4) and have the ability to complete short surveys online independently or assisted by a caregiver.
Clinician participant inclusion criteria:
We will include physicians who provide care to women with symptomatic uterine fibroids during the project duration at participating project sites.
Our stepped-wedge implementation design
(1)Pre-implementation (6 months): This serves as our baseline phase for each project site. We will assess each organization's readiness for patient engagement.
(2)Initiation (2 months): This marks the introduction of the intervention tools for participating clinicians.
(3)Active implementation (6 months): This is the phase where we ask each participating clinician to use the tools with all eligible patients. Each project site gets 6 months to use these decision aid tools with each of their eligible patients.
(4)Sustainability (0-8 months): The implementation of the tools will no longer be supported or measured by the researchers so we can see whether the implementation methods at each site result in sustainable use of the tools.