Implementing shared decision making in Denmark: First steps and future focus areas

Steffensen, Karina Dahl; Baker, Vibe Hjelholt; Vinter, Mette Marianne

doi:10.1016/j.zefq.2017.05.005

Cited by 26 publications

(26 citation statements)

References 4 publications

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“…Moreover, together with an iterative process of experience gathering and reflection, clinical participation in the development process has previously been found a fundamental feature for accomplishing engagement and ownership of newly developed initiatives and thereby a prerequisite for successful implementation . Additionally, organizational readiness and a strongly committed, visionary, and visible management team, who supports the implementation at all organizational levels, have previously been identified as crucial for the success and sustainability of new initiatives . Our study corroborates these previous findings.…”

Section: Discussionsupporting

confidence: 87%

Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective

Jørgensen

Pedersen

Martin³

et al. 2019

Evaluation Clinical Practice

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Rationale, aims and objectives: Patient involvement is increasingly recognized as a key component on the international health care agenda. This attention has brought a need for developing generic and standardized open-source methods, tools, and guidelines on how to systematically implement patient involvement initiatives in the clinical setting. The large-scale project the User-involving Hospital was initiated to implement two systematic methods for patient involvement at a Danish university hospital, but the required methods can only be implemented if embraced by the health professionals. This evaluation study aimed to explore the health professional perspective on the development and implementation of shared decision making (SDM) and userled health care. Specifically, the objectives were to identify the most crucial preconditions for success and to translate the findings into practice recommendations. Method:The study was based on a simple questionnaire survey and a qualitative descriptive analysis of semistructured focus group interviews with representatives of 21 multidisciplinary clinical teams (nine interviews) and 18 health professional department managers (six interviews).Results: Two years after the initiation of the User-involving Hospital, 13 out of 21 developed patient involvement initiatives were fully incorporated into clinical practice. Five domains were found significant for successful development and implementation of the patient involvement methods: the patients' perspectives, composition of multidisciplinary teams, bottom-up and skill building, support from management, and information sharing with colleagues. Conclusions: The findings draw attention to several significant factors for successful implementation of large-scale patient involvement initiatives in hospitals, including the importance of having both a top-down and bottom-up approach and of active listening to the patients' perspectives. On the basis of these findings, the study outlines four recommendations incorporating the five identified key domains, which may inspire future projects on systematic development and implementation of patientinvolvement initiatives based on either shared decision making or user-led health care in the clinical setting.

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Section: Discussionsupporting

confidence: 87%

Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective

Jørgensen

Pedersen

Martin³

et al. 2019

Evaluation Clinical Practice

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“…Two reviewers (N.J.-W. and T.v.d.W.) conducted a scoping exercise of existing literature examining barriers and facilitators to implementing PtDAs and SDM 9 , 11 – 13 , 16 , 25 , 29 , 30 to agree on the review questions and scope and to generate initial theories. The a priori proposal was reviewed and approved by the IPDAS Steering Committee and registered with PROSPERO (CRD42019153334).…”

Section: Methodsmentioning

confidence: 99%

What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration

et al. 2020

Self Cite

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Background Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting. Aim This review was conducted in response to the IPDAS Collaboration’s evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings. Methods Rapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research. Results We developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve. Conclusions We recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.

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“…Involving patients in health care is on the political agenda in many countries today. In Denmark, patient-centered care has been put on the national agenda [ 18 ]. In the Danish health care system, patients and their relatives should be involved in treatment and health care, and this is monitored in relation to national quality targets [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the Danish health care system, SDM is not yet a standard practice among health care professionals despite good intentions [ 18 ]. A Danish survey from 2014 among 539 doctors and 824 nurses, found that the clinicians want to involve patients in their practice but think implementation is difficult due to lack of resources, knowledge and methods [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Pelvic organ prolapse and treatment decisions– developing an online preference-sensitive tool to support shared decisions

Hulbæk

Knutz

Ebbesen

et al. 2020

BMC Med Inform Decis Mak

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Background Female patients with pelvic organ prolapse and clinicians need to take decisions regarding treatment that are often unpredictable in relation to how they impact the future everyday lives of the patients. This study formed the developmental phase of a larger study to develop and test an online tool to support shared decision-making. Methods Patients, health care professionals and other stakeholders participated in the development and evaluation process of this tool. The collected data was generated from observational studies, exploratory interviews with prompt cards and workshops with end users from four Danish gynecology outpatient clinics. Results Content analysis led to important themes. For the patients three themes emerged: 1) how the impact of symptoms on everyday life affected the need for relief, 2) their bodily perception and sex life and 3) their worries about the future. For clinicians the different symptoms and their severity was a main theme. Conclusions This article provides an overall description and discussion of the development methodology. It demonstrates how user involvement informed the prototyping process and how patients’ preferences were included in the final prototype. Whether the tool actually increases SDM, remains to be tested in a pilot feasibility study.

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Implementing shared decision making in Denmark: First steps and future focus areas

Cited by 26 publications

References 4 publications

Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective

Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective

What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration

Pelvic organ prolapse and treatment decisions– developing an online preference-sensitive tool to support shared decisions

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