Tradeoffs between pace and reach of patient decision aids: a case study adapting a breast reconstruction decision aid from clinical implementation to social media dissemination

Background Patient decision aids (PtDAs) support shared decision making and can improve patient outcomes. Nevertheless, PtDAs have not been widely adopted in healthcare settings because of numerous patient-, clinician-, and organizational-level factors. To address the slow pace of implementation and limited reach of PtDAs, we adapted a PtDA from implementation through the electronic health record in clinical settings for dissemination on social media and online communities. Methods We describe the adaptation of BREASTChoice, a PtDA about breast reconstruction after mastectomy, originally used in clinical settings and the electronic health record (EHR), for dissemination through social media and online communities. We conducted focus groups and interviews with patients and topical experts to guide the adaptation process, using Rogers’ Diffusion of Innovations and ADAPT-ITT, and tracked adaptations using FRAME. Findings Based on our findings, we propose a model that identifies differences in accelerators and inhibitors of BREASTChoice and its implementation and dissemination strategies, with the goal of outlining how speed of implementation and dissemination can differ between contexts. Implications for dissemination and implementation research This study provides a model that explicitly outlines the potential determinants of implementation and dissemination of PtDAs both within and outside of health settings. Evaluating these determinants will help researchers and PtDA developers to increase speed and reach of PtDAs while maintaining scientific rigor.