UMMS Affiliation

Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine; Division of Geriatrics, Department of Medicine

Publication Date


Document Type



Health Policy | Health Services Administration | Health Services Research


The Centers for Medicare and Medicaid Services (CMS) has mandated shared decision making (SDM) using patient decision aids for three conditions (lung cancer screening, atrial fibrillation, and implantable defibrillators). These forward-thinking approaches are in response to a wealth of efficacy data demonstrating that decision aids can improve patient decision making. However, there has been little focus on how to implement these approaches in real-world practice. This article demonstrates how using an implementation science framework may help programs understand multilevel challenges and opportunities to improve adherence to the CMS mandates. Using the PRISM (Pragmatic Robust Implementation and Sustainability Model) framework, we discuss general challenges to implementation of SDM, issues specific to each mandate, and how to plan for, enhance, and assess SDM implementation outcomes. Notably, a theme of this discussion is that successful implementation is context-specific and to truly have successful and sustainable changes in practice, context variability, and adaptation to context must be considered and addressed.


CMS mandates, PRISM, context, framework, implementation science, shared decision making

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Copyright © The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

DOI of Published Version



Matlock DD, Fukunaga MI, Tan A, Knoepke C, McNeal DM, Mazor KM, Glasgow RE. Enhancing Success of Medicare's Shared Decision Making Mandates Using Implementation Science: Examples Applying the Pragmatic Robust Implementation and Sustainability Model (PRISM). MDM Policy Pract. 2020 Oct 15;5(2):2381468320963070. doi: 10.1177/2381468320963070. PMID: 33117890; PMCID: PMC7570787. Link to article on publisher's site

Journal/Book/Conference Title

MDM policy and practice

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Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License