{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:52:59Z","timestamp":1782492779028,"version":"3.54.5"},"reference-count":35,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18 HS029300-01"],"award-info":[{"award-number":["R18 HS029300-01"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,27]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Preimplementation qualitative study using semistructured interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Three academic medical centres in the southeastern and western USA. Interviews were conducted between 27 March and 25 September 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>36 participants, including 19 clinicians involved in prescribing or managing anticoagulants and seventeen patients prescribed anticoagulants, were recruited using purposive and convenience sampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This preimplementation qualitative study identified context-specific determinants that influence the adoption of an electronic shared decision-making tool for anticoagulant-related drug\u2013drug 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110074","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:55:34Z","timestamp":1773327334000},"page":"e110074","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to implementing a shared decision-making tool for anticoagulant-related drug\u2013drug interactions: a qualitative study across three academic medical centres in the USA"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1583-4994","authenticated-orcid":false,"given":"Robert A","family":"Becker","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemberlee","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA"},{"name":"Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauli V","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Dang","sequence":"additional","affiliation":[{"name":"College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica S","family":"Ancker","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy E","family":"Trinkley","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA"},{"name":"Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ainhoa","family":"Gomez-Lumbreras","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-6799","authenticated-orcid":false,"given":"Guilherme","family":"Del Fiol","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4282-9338","authenticated-orcid":false,"given":"Kensaku","family":"Kawamoto","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman G","family":"Tawfik","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Cornia","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubrey E","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J","family":"Reese","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"2026062609361981000_16.3.e110074.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38398.500764.8F"},{"key":"2026062609361981000_16.3.e110074.2","doi-asserted-by":"crossref","DOI":"10.1186\/s43058-022-00326-x","article-title":"Barriers and enablers to implementing and using clinical decision support systems for chronic diseases: a qualitative systematic review and meta-aggregation","volume":"3","author":"Chen","year":"2022","journal-title":"Implement Sci Commun"},{"key":"2026062609361981000_16.3.e110074.3","doi-asserted-by":"crossref","DOI":"10.1038\/s41746-025-01662-7","article-title":"A systematic review of clinicians\u2019 acceptance and use of clinical decision support systems over time","volume":"8","author":"Newton","year":"2025","journal-title":"NPJ Digit Med"},{"key":"2026062609361981000_16.3.e110074.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-021-01181-5","article-title":"Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"2026062609361981000_16.3.e110074.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-023-01285-0","article-title":"The relative value of Pre-Implementation stages for successful implementation of evidence-informed programs","volume":"18","author":"Alley","year":"2023","journal-title":"Implement Sci"},{"key":"2026062609361981000_16.3.e110074.6","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2077-6"},{"key":"2026062609361981000_16.3.e110074.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j4891","article-title":"A three-talk model for shared decision making: multistage consultation process","volume":"359","author":"Elwyn","year":"2017","journal-title":"BMJ"},{"key":"2026062609361981000_16.3.e110074.8","article-title":"Decision aids for people facing health treatment or screening decisions","volume":"1","author":"Stacey","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062609361981000_16.3.e110074.9","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1093\/jnci\/djad133","article-title":"The decision aid is the easy part: workflow challenges of shared decision making in cancer care","volume":"115","author":"Salwei","year":"2023","journal-title":"J Natl Cancer Inst"},{"key":"2026062609361981000_16.3.e110074.10","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1177\/0272989X18801308","article-title":"Informed, Patient-Centered Decisions Associated with Better Health Outcomes in Orthopedics: Prospective Cohort Study","volume":"38","author":"Sepucha","year":"2018","journal-title":"Med Decis Making"},{"key":"2026062609361981000_16.3.e110074.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2021.1693","article-title":"National Trends in Use of and Spending on Oral Anticoagulants Among US Medicare Beneficiaries From 2011 to 2019","volume":"2","author":"Troy","year":"2021","journal-title":"JAMA Health Forum"},{"key":"2026062609361981000_16.3.e110074.12","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/joim.20067","article-title":"Excess risk of bleeding in patients with venous thromboembolism on direct oral anticoagulants during initial and extended treatment versus population controls","volume":"297","author":"Glise Sandblad","year":"2025","journal-title":"J Intern Med"},{"key":"2026062609361981000_16.3.e110074.13","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvz069"},{"key":"2026062609361981000_16.3.e110074.14","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp040567"},{"key":"2026062609361981000_16.3.e110074.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.063"},{"key":"2026062609361981000_16.3.e110074.16","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.3208","article-title":"Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding","volume":"7","author":"Rahman","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026062609361981000_16.3.e110074.17","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2021.2017474"},{"key":"2026062609361981000_16.3.e110074.18","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.amjmed.2025.06.034","article-title":"Outcomes of Oral Anticoagulation with Concomitant NSAID Use: A Registry Based Cohort Study","volume":"138","author":"Ardeshna","year":"2025","journal-title":"Am J Med"},{"key":"2026062609361981000_16.3.e110074.19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10557-023-07521-5","article-title":"Pharmacodynamic Drug-Drug Interactions and Bleeding Outcomes in Patients with Atrial Fibrillation Using Non-Vitamin K Antagonist Oral Anticoagulants: a Nationwide Cohort Study","volume":"39","author":"Grymonprez","year":"2025","journal-title":"Cardiovasc Drugs Ther"},{"key":"2026062609361981000_16.3.e110074.20","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/eurheartj\/ehae736","article-title":"Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study","volume":"46","author":"Petersen","year":"2025","journal-title":"Eur Heart J"},{"key":"2026062609361981000_16.3.e110074.21","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1710592"},{"key":"2026062609361981000_16.3.e110074.22","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocv027"},{"key":"2026062609361981000_16.3.e110074.23","doi-asserted-by":"publisher","DOI":"10.1136\/jamia.2010.005264"},{"key":"2026062609361981000_16.3.e110074.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2008.07.018"},{"key":"2026062609361981000_16.3.e110074.25","doi-asserted-by":"crossref","DOI":"10.2196\/28618","article-title":"A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study","volume":"8","author":"Reese","year":"2021","journal-title":"JMIR Hum Factors"},{"key":"2026062609361981000_16.3.e110074.26","doi-asserted-by":"crossref","DOI":"10.2196\/40018","article-title":"Shared Decision-Making for Drug-Drug Interactions: Formative Evaluation of an Anticoagulant Drug Interaction","volume":"6","author":"Gomez Lumbreras","year":"2022","journal-title":"JMIR Form Res"},{"key":"2026062609361981000_16.3.e110074.27","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026062609361981000_16.3.e110074.28","doi-asserted-by":"crossref","first-page":"2743","DOI":"10.1093\/jamia\/ocab195","article-title":"Guidance for publishing qualitative research in informatics","volume":"28","author":"Ancker","year":"2021","journal-title":"J Am Med Inform Assoc"},{"key":"2026062609361981000_16.3.e110074.29","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"2026062609361981000_16.3.e110074.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-017-2048-z","article-title":"Study protocol: improving the transition of care from a non-network hospital back to the patient\u2019s medical home","volume":"17","author":"Ayele","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"2026062609361981000_16.3.e110074.31","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"2026062609361981000_16.3.e110074.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232076","article-title":"A simple method to assess and report thematic saturation in qualitative research","volume":"15","author":"Guest","year":"2020","journal-title":"PLoS One"},{"key":"2026062609361981000_16.3.e110074.33","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/1468794120976072","article-title":"Beyond a coefficient: an interactive process for achieving inter-rater consistency in qualitative coding","volume":"22","author":"Hemmler","year":"2022","journal-title":"Qual Res"},{"key":"2026062609361981000_16.3.e110074.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2013.10.031"},{"key":"2026062609361981000_16.3.e110074.35","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000350"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:40:44Z","timestamp":1782492044000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjopen-2025-110074"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110074","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}