Moving from a clinical trial to routine care: a qualitative analysis of primary care physicians’ experiences with interventions to promote shared decision making for colorectal cancer screening in older adults

Abstract Background The Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED) cluster randomized trial found that 2-hour online training combined with a pre-visit reminder for primary care physicians (PCPs) increased shared decision making (SDM) among patients aged 76–85 years who were due for colorectal cancer screening (CRC) screening discussions. However, the best way to translate findings from the clinical trial setting into routine primary care remains unclear. Objective To explore PCPs’ experiences with the PRIMED SDM training and reminders, and to identify barriers, facilitators, and recommendations for implementation in routine primary care. Methods A qualitative study using semi-structured interviews was conducted. 59 PCPs from 35 primary care practices affiliated with five hospitals in Massachusetts and Maine who participated in the PRIMED trial were invited to be interviewed. Interviews were conducted between April and July 2021, transcribed verbatim, and analyzed by two independent researchers using a Framework Analysis-informed approach. Results Of 59 PCPs, 43 participated. Themes included: (i) Training and Reminders Supported SDM; (ii) Real-World Constraints Challenged SDM Implementation, but PCPs Made Efforts to Adapt despite challenges such as time pressures, competing priorities, and the COVID-19 pandemic; and (iii) Scaling and Sustaining SDM Requires a System-Level Approach, such as automated reminders, patient decision aids, concise training, and interprofessional SDM. Conclusions Overall, PCPs perceived the SDM training and reminders as supporting a more nuanced and individualized approach to CRC screening conversations with older adults. To enable broader scale-up in primary care, these interventions should minimize burden on PCPs by streamlining integration into existing workflows.