Abstract
BackgroundShared decision making (SDM) is at the core of policy measures for making healthcare person-centred. However, the context-sensitive nature of the challenges in integrated stroke care calls for research to facilitate its implementation. This before and after evaluation study identifies factors for implementation and concludes with key recommendations for adoption.MethodsData were collected at the start and end of an implementation programme in five stroke services (December 2017 to July 2018). The SDM implementation programme consisted of training for healthcare professionals (HCPs), tailored support, development of decision aids and a social map of local stroke care. Participating HCPs were included in the evaluation study: A questionnaire was sent to 25 HCPs at baseline, followed by 11 in-depth interviews. Data analysis was based on theoretical models for implementation and 51 statements were formulated as a result. Finally, all HCPs were asked to validate and to quantify these statements and to formulate recommendations for further adoption.ResultsThe majority of respondents said that training of all HCPs is essential. Feedback on consultation and peer observation are considered to help improve performance. In addition, HCPs stated that SDM should also be embedded in multidisciplinary meetings, whereas implementation in the organisation could be facilitated by appointed ambassadors. Time was not seen as an inhibiting factor. According to HCPs, negotiating patients’ treatment decisions improves adherence to therapy. Despite possible cognitive or communications issues, all are convinced patients with stroke can be involved in a SDM-process. Relatives play an important role too in the further adoption of SDM. HCPs provided eight recommendations for adoption of SDM in integrated stroke care.ConclusionsHCPs in our study indicated it is feasible to implement SDM in integrated stroke care and several well-known implementation activities could improve SDM in stroke care. Special attention should be given to the following activities: (1) the appointment of knowledge brokers, (2) agreements between HCPs on roles and responsibilities for specific decision points in the integrated stroke care chain and (3) the timely investigation of patient’s preferences in the care process – preferably before starting treatment through discussions in a multidisciplinary meeting.
Highlights
Shared decision making (SDM) is at the core of policy measures for making healthcare personcentred
Specific research questions were: According to Healthcare professional (HCP), is SDM feasible for patients that suffer from stroke? What factors influence the implementation of SDM? What does this mean for the further embedding of SDM in Dutch integrated stroke care?
The healthcare provider and the preconditions regarding the organisation According to the majority of HCPs, “it is important that all HCPs involved are trained in SDM” (Table 3, statement 8)
Summary
Shared decision making (SDM) is at the core of policy measures for making healthcare personcentred. The context-sensitive nature of the challenges in integrated stroke care calls for research to facilitate its implementation. Research has underlined the positive outcomes of SDM in terms of benefits for patients, including improved understanding, satisfaction, trust, treatment adherence and health outcomes [3]. Multifaceted implementation strategies among HCPs, their organisations and patients to deal with barriers and facilitators for change can improve SDM in clinical practice. Examples are tapping into motivations to engage with SDM, providing training with role play, aiming for quality improvement and monitoring outcomes, using local facilitators, using SDM tools that are tailored to the setting, creating mapping tools to help understand how care pathways can support SDM and where the decision points are [5]
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