P084 Implementing an osteoporosis shared decision-making intervention in Fracture Liaison Services: interview findings from the iFraP process evaluation

Bullock, Laurna; Cherrington, Andrea; Clark, Emma M; Fleming, Jane; Bentley, Ida; Nicholls, Elaine; Webb, David; Smith, Jo; Lewis, Sarah; Horne, Robert; O’Neill, Terence W; Mallen, Christian D; Jinks, Clare; Paskins, Zoe

Abstract

Background/Aims High quality shared decision-making (SDM) conversations involve people with or at risk of osteoporosis and clinicians working together to reach decisions about care. The improving uptake of Fracture Prevention drug treatments (iFraP) randomised controlled trial (RCT) tested a SDM intervention, comprising a computerised Decision Support Tool (DST), clinician training package, and information resources, in four UK Fracture Liaison Services (FLSs). The nested iFraP process evaluation aimed to explore perceived intervention acceptability, implementation, and the hypothesised mechanisms of impact and outcomes, including any contextual factors associated with variation. Methods The iFraP process evaluation included semi-structured interviews with consenting (1) patients who received the iFraP intervention in their face-to-face or telephone FLS appointment; (2) FLS clinicians delivering the iFraP appointments; and (3) primary care clinicians who consulted with a patient following their FLS appointment. Data were analysed using a framework approach. The Normalisation Process Theory facilitated data interpretation to unpick the ‘work’ required to implement the iFraP intervention. Results Interviews were completed with 21 patients (90% female; mean age 66 years [range 54 - 82]), eight FLS clinicians, and two general practitioners (GPs). Overall, the intervention was viewed as acceptable by patients and FLS clinicians. This was reinforced by many wishing for the intervention to be incorporated as part of usual care and some clinicians requesting to use the intervention outside of the trial context. All patients who had a face-to-face appointment reflected that the DST had been used by the clinician and they had received the information resources. In contrast, patients who received a telephone appointment were less certain about the clinician’s use of the DST and some reported not receiving the information resources. This potentially highlights process barriers when sending information resources to patients by post. Patients described engaging with the iFraP DST as requiring no extra work. In contrast, the work required for FLS clinicians to integrate the intervention into clinical practice varied, with some reflecting that the DST required no extra work, whereas others voiced challenges because of existing appointment lengths, IT skills, and adapting their established consultation ‘flow’. Despite this, most clinicians perceived the extra work as worthwhile because of perceived patient benefit. The iFraP intervention was hypothesised to improve decision-making about osteoporosis medicines. In line with this, most patients and clinicians reflected that the intervention prompted patient involvement in discussions, elicited patient perceptions, and supported consistent, tailored and accessible information sharing. Conclusion The iFraP intervention was perceived as acceptable and implementable in FLS, with the potential to support SDM about osteoporosis medicines. Telephone consultations may impact the implementation of SDM interventions. Interview findings will be integrated with other process evaluation components to generate further insights about the iFraP intervention. Disclosure L. Bullock: None. A. Cherrington: None. E.M. Clark: None. J. Fleming: None. I. Bentley: None. E. Nicholls: None. D. Webb: None. J. Smith: None. S. Lewis: None. R. Horne: None. T.W. O’Neill: Grants/research support; NIHR Manchester Biomedical Research Centre. C.D. Mallen: Grants/research support; NIHR Applied Research Collaboration West Midlands, NIHR School for Primary Care Research. C. Jinks: Grants/research support; NIHR Applied Research Collaboration (ARC) West Midlands. Z. Paskins: Consultancies; received consultancy fees from UCB Pharma. Grants/research support; National Institute for Health and Care Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].

Citation

Bullock, L., Cherrington, A., Clark, E. M., Fleming, J., Bentley, I., Nicholls, E., Webb, D., Smith, J., Lewis, S., Horne, R., O’Neill, T. W., Mallen, C. D., Jinks, C., & Paskins, Z. (2025, April). P084 Implementing an osteoporosis shared decision-making intervention in Fracture Liaison Services: interview findings from the iFraP process evaluation. Poster presented at British Society for Rheumatology Annual Conference 2025, Manchester Central Convention Complex, Manchester, England, UK

• Presentation Conference Type: Poster
• Conference Name: British Society for Rheumatology Annual Conference 2025
• Start Date: Apr 28, 2025
• End Date: Apr 30, 2025
• Acceptance Date: Apr 28, 2025
• Online Publication Date: Apr 28, 2025
• Publication Date: Apr 1, 2025
• Deposit Date: Jun 6, 2025
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/keaf142.124
• Public URL: https://keele-repository.worktribe.com/output/1242646
• Publisher URL: https://academic.oup.com/rheumatology/article/64/Supplement_3/keaf142.124/8115011