Are shared decision making studies well enough described to be replicated? Secondary analysis of a Cochrane systematic review

Abstract

Background Interventions to change health professionals’ behaviour are often difficult to replicate. Incomplete reporting is a key reason and a source of waste in health research. We aimed to assess the reporting of shared decision making (SDM) interventions. Methods We extracted data from a 2017 Cochrane systematic review whose aim was to determine the effectiveness of interventions to increase the use of SDM by healthcare professionals. In a secondary analysis, we used the 12 items of the Template for Intervention Description and Replication (TIDieR) checklist to analyze quantitative data. We used a conceptual framework for implementation fidelity to analyze qualitative data, which added details to various TIDieR items (e.g. under “what materials?” we also reported on ease of access to materials). We used SAS 9.4 for all analyses. Results Of the 87 studies included in the 2017 Cochrane review, 83 were randomized trials, three were non-randomized trials, and one was a controlled before-and-after study. Items most completely reported were: “brief name” (87/87, 100%), “why” (rationale) (86/87, 99%), and “what” (procedures) (81/87, 93%). The least completely reported items (under 50%) were “materials” (29/87, 33%), “who” (23/87, 26%), and “when and how much” (18/87, 21%), as well as the conditional items: “tailoring” (8/87, 9%), “modifications” (3/87, 4%), and “how well (actual)” (i.e. delivered as planned?) (3/87, 3%). Interventions targeting patients were better reported than those targeting health professionals or both patients and health professionals, e.g. 84% of patient-targeted intervention studies reported “How”, (delivery modes), vs. 67% for those targeting health professionals and 32% for those targeting both. We also reported qualitative analyses for most items. Overall reporting of items for all interventions was 41.5%. Conclusions Reporting on all groups or components of SDM interventions was incomplete in most SDM studies published up to 2017. Our results provide guidance for authors on what elements need better reporting to improve the replicability of their SDM interventions.

Co-designing a theory-informed intervention to increase shared decision-making in maternity care

“…There is robust evidence for the benefits of continuity of care models [55,56]; however, there is limited funding available for health services, with only 8% of patients funded [57]. Waddell et al Health Research Policy and Systems (2023) 21:15 Further strengths of this study include a strong codesign focus, addressing a lack of stakeholder engagement in previous interventions aiming to educate patients on their options, risks and benefits [50,58] and use of behavioural science theory to underpin intervention development, which is rare in maternity care SDM intervention development [25,26,59]. The use of the TDF, BCW and TATT ensured co-designed interventions were based on theory and evidence while being appropriate for the specific context in which they would be employed [32], thus increasing their chance of success compared with interventions designed without theory and evidence [26,29,30].…”

“…SDM research more broadly has predominantly occurred in primary and secondary care settings and tends to focus on patient and clinician barriers and facilitators to SDM, rather than organizational or systemic barriers and facilitators [23,24]. Furthermore, much of the research to date lacks clear evidence for what facilitates the use of SDM, either due to unclear reporting or due to a lack of theory underpinning intervention design [25,26].…”

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

“…63 SDM research is often criticized for its lack of theory and unclear reporting. 64 A strength of this study is the use of the TDF and COREQ for the systematic design, data collection, analysis, and reporting. The use of the TDF allows for future intervention research to build on the available behavioral science evidence base.…”