Practitioners’ views on shared decision-making implementation: A qualitative study
Hajar Hasannejadasl,
The Netherlands
PO-1048
Abstract
Practitioners’ views on shared decision-making implementation: A qualitative study
Authors: Anshu Ankolekar1, Karina Dahl Steffensen2, Karina Olling3, Andre Dekker1, Leonard Wee1, Cheryl Roumen1, Hajar Hasannejadasl1, Rianne Fijten1
1Maastricht University, Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands; 2Lillebaelt Hospital – University Hospital of Southern Denmark, Department of Oncology, Vejle, Denmark; 3Lillebaelt Hospital – University Hospital of Southern Denmark, Center for Shared Decision Making, Vejle, Denmark
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Purpose or Objective
Shared decision-making (SDM) is the collaboration between patients and clinicians to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored Danish practitioners’ experiences in a clinic where SDM has been successfully implemented. The aim was to identify success factors according to practitioners.
Material and Methods
We used a qualitative approach to examine the experiences of 10 practitioners with a clinical background who were involved in the SDM initiative, e.g. practicing oncologists, nurses, team leaders, and researchers. Semi-structured interviews focused on: (i) participants’ experiences with usual care and initial impressions of the SDM paradigm; (ii) experiences of SDM training; (iii) using paper-based PDAs in practice; (iv) challenges of putting SDM into practice; (v) effects of SDM on the consultation process and outcomes; (vi) implementation success factors and remaining challenges. Interview transcripts were analyzed with thematic analysis, a reflexive method for coding and identifying patterns in qualitative data.
Results
The full thematic map of our findings is given in Fig. 1. Prior to SDM implementation, participants’ attitudes were roughly evenly distributed between skeptical and receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM.
We identified four main themes for successful SDM implementation:
- Raising clinician awareness of SDM behaviors: prior to SDM implementation, the level of patient involvement was measured using the OPTION-12 scale. Patients and clinicians also participated together in PDA development. These two factors made clinicians aware of the gap between current practice and an ideal SDM process.
- Reinforcement: clinicians used in-consultation paper PDAs structured according to a 5-step SDM model. These structured PDAs helped reinforce the SDM steps so that new habits could be sustained.
- Flexibility: an online platform was created, with generic PDA templates that could be customized by clinicians, giving them flexibility to apply SDM in different clinical contexts.
- Leadership: Strong leadership was instrumental in driving these changes, beginning with a clear strategic vision, ongoing communication with clinicians, and empowering them to lead SDM training through a Train-the-trainer teaching format.
Fig 1. Thematic map of themes and subthemes
Conclusion
Practicing SDM involves a major shift in mindset for clinicians and our results indicate that it is crucial to design SDM initiatives based on motivational and behavioral mechanisms such as ownership and self-efficacy. A limitation of our study is that we cannot determine the relative importance of the success factors identified. Further research may explore the interplay between these factors and compare paper and digital PDAs to determine which format patients and clinicians find more informative and user-friendly.