Implementing a shared decision‐making and cognitive strategy‐based intervention: Knowledge user perspectives and recommendations

Abstract

The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision‐making (SDM)‐based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy‐based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO‐OP) to treat survivors of stroke. At the end of the 4‐month CO‐OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO‐OP site champions. A semi‐structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio‐recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO‐OP implementation were extracted and co‐constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context‐specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem‐solving within the relevant practice context.

Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

“…Of these, 520 were further screened based on the full text. 14 articles were deemed to meet all inclusion and exclusion criteria [ 44 – 57 ]. A review of reference lists of relevant systematic reviews did not identify any additional studies for inclusion.…”

“…Included articles used qualitative study designs, with the majority using interviews [ 44 , 46 – 48 , 50 – 52 , 55 – 57 ], followed by focus groups [ 44 , 46 , 51 , 54 ], observation [ 49 , 53 ], and conference breakout session [ 45 ].…”

“…Seven countries were represented across the included articles including the USA [ 45 , 47 , 48 , 55 – 57 ], Canada [ 44 , 49 , 57 ], Germany [ 53 , 54 ], The Netherlands [ 46 ], Australia [ 50 ], UK [ 51 ], and France [ 57 ] (Additional File 2 ).…”

Editorial introduction: Decision making, reasoning, context, and perspective

“…[18][19][20] The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts. It would of course be misleading to present this edition as the "conclusion" of the debate commenced in our previous thematic issue on this subject.…”

“…The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM . Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts.…”