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Table 2 Endogenous factors that promote or inhibit the implementation of DSTs

From: Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice

User groups Physicians Patients Managers
Interactional Workability ▪ Enrolling patients in shared decision-making ▪ Concept of shared decision-making ▪ Ensuring efficient and safe interactions.
  ▪ Making DST available ▪ New role as participant  
  ▪ Integrating DST in the consultation ▪ Cognitive engagement with DST  
  ▪ Managing time to process patients ▪ Understanding and assessing outcomes  
  ▪ Managing patients who do not enter into shared decision-making ▪ Decisional responsibility  
Relational Integration ▪ Linking DST to evidence base ▪ Making sense of clinical knowledge ▪ Assessing the value of evidence
  ▪ Confidence in applicability to individual patients. ▪ Agenda setting over treatment outcomes ▪ Understanding professional engagement
  ▪ Matching clinical evidence with patient knowledge   ▪ Defining and evaluating 'best practice'
  ▪ Deciding on patients' accountability for engaging with DSTs   
  ▪ Dealing with safety and liability.