N21 Shared Decision Making: A Qualitative Exploration of Clinical Nurse Specialists in Gastroenterology

Abstract

Abstract Background Clinical Nurse Specialists (CNS) participation in the Shared Decision Making (SDM) process and understanding basic concepts and principles related to the decision-making process are critical. (Storms et al. 2015). The core concept role of CNS includes a clinical focus on direct and indirect care of the patients in the specialist area, health educator and trainer, patient advocate, audit and research and consultation (NCNM, 2008). They have many opportunities to participate in the SDM process with patients arising from clinic visits, telephone helpline services and multidisciplinary team meetings. Nurses are progressively deemed influential in shared decision-making; however, studies on the SDM role of the CNS are limited; our study investigates the experiences of CNS in SDM, in the speciality of gastroenterology (GI) in both medical and surgical. Methods This study adopted a qualitative descriptive style. The survey was distributed to medical and surgical GI CNS at a tertiary referral hospital. This study aimed to look at three aspects of CNS's SDM experience: the CNS's knowledge about SDM, generating discussion and coordination, and respect for sociocultural factors. Semi-depth interviews were conducted for data collection. There were 11CNS participants from surgical and medical GI specialities, including IBD, hepatology, endoscopy, upper GI, and colorectal nursing. All interviews were recorded and transcribed verbatim and coded. Results Six themes emerged from the data collected: perceptions, attitudes, positive change, influential factors, reflection and obstacles. SDM is an unknown concept for the majority of the CNS.CNS self-identified as integral to the speciality and the patient's primary contact. Conclusion CNS has little understanding of the SDM concept. SDM is perceived as MDT (Multi-Disciplinary Team) making decisions without patient involvement. Formal education and increased awareness of the SDM process are essential for CNS active participation in individual patients. The procured knowledge of SDM enhances the CNS's confidence in active participation in MDT team meetings and the SDM process. It consequently improves patient experience, knowledge and participation in the SDM process.