{
  "abstract": "Objectives To identify barriers and facilitators to implementing an electronic shared decision-making tool for managing anticoagulant-related drug-drug interactions that affect bleeding risk in routine clinical care.Design Preimplementation qualitative study using semistructured interviews.Setting Three academic medical centres in the southeastern and western USA. Interviews were conducted between 27 March and 25 September 2024.Participants 36 participants, including 19 clinicians involved in prescribing or managing anticoagulants and seventeen patients prescribed anticoagulants, were recruited using purposive and convenience sampling.Results Participants identified multiple barriers and facilitators to tool implementation. Common barriers included limited visit time, challenges integrating the tool into existing workflows, role and scope-of-practice constraints, and variation in patient digital literacy. Facilitators included clear visualisation of bleeding risk, access to supporting evidence, familiar interface design and perceived potential to support patient engagement and shared decision-making. Several determinants functioned as both barriers and facilitators, depending on clinical context and user role.Conclusions This preimplementation qualitative study identified context-specific determinants that influence the adoption of an electronic shared decision-making tool for anticoagulant-related drug–drug interactions. Findings highlight the importance of early attention to workflow integration, role alignment and usability to support uptake in routine care. Addressing these factors during design and implementation may inform strategies to support adoption and future evaluation in real-world clinical settings.",
  "authors": [
    {
      "affiliations": [
        "Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA"
      ],
      "name": "Robert A Becker"
    },
    {
      "affiliations": [
        "Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA",
        "Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Kemberlee Bonnet"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Mauli V Shah"
    },
    {
      "affiliations": [
        "College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA"
      ],
      "name": "Elizabeth Dang"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Jessica S Ancker"
    },
    {
      "affiliations": [
        "Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"
      ],
      "name": "Daniel C Malone"
    },
    {
      "affiliations": [
        "Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA",
        "Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado, USA"
      ],
      "name": "Katy E Trinkley"
    },
    {
      "affiliations": [
        "Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"
      ],
      "name": "Ainhoa Gomez-Lumbreras"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Guilherme Del Fiol"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Kensaku Kawamoto"
    },
    {
      "affiliations": [
        "Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"
      ],
      "name": "Abdelrahman G Tawfik"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Ryan Cornia"
    },
    {
      "affiliations": [
        "Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"
      ],
      "name": "Aubrey E Jones"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA"
      ],
      "name": "James Mitchell"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Thomas J Reese"
    }
  ],
  "title": "Barriers and facilitators to implementing a shared decision-making tool for anticoagulant-related drug–drug interactions: a qualitative study across three academic medical centres in the USA",
  "uid": "121103ca-4ed0-56cf-b49e-d1b6bdd439a9"
}