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Abstract
BackgroundDespite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers’ views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice.Material and MethodsA qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics.ResultsN = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship.ConclusionThe results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.
Highlights
Patient-centered care and patient involvement in healthcare decisions have become key components in high-quality modern healthcare [1,2,3,4,5,6]
Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany
The present study aimed at exploring a) the attitudes of different healthcare providers regarding Shared decision-making (SDM) in oncology and b) their experiences with treatment decisions in daily practice
Summary
Patient-centered care and patient involvement in healthcare decisions have become key components in high-quality modern healthcare [1,2,3,4,5,6]. Shared decision-making (SDM) has been fostered as the pinnacle of patient-centered care [9]. SDM is defined as an interactional process in which the patient and the clinician aim to reach a decision together that is based on shared information and the best available evidence [10]. In the course of this process, the clinician supports the patient in weighing the risks and benefits of different diagnostic or treatment options, in order to come to a shared and informed decision [11]. Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice
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