Improvement of shared decision making in integrated stroke care: a before and after evaluation using a questionnaire survey

Abstract

BackgroundShared decision making (SDM) is at the core of policy measures for making healthcare person-centred. However, the context-sensitive nature of the challenges in integrated stroke care calls for research to facilitate its implementation. This before and after evaluation study identifies factors for implementation and concludes with key recommendations for adoption.MethodsData were collected at the start and end of an implementation programme in five stroke services (December 2017 to July 2018). The SDM implementation programme consisted of training for healthcare professionals (HCPs), tailored support, development of decision aids and a social map of local stroke care. Participating HCPs were included in the evaluation study: A questionnaire was sent to 25 HCPs at baseline, followed by 11 in-depth interviews. Data analysis was based on theoretical models for implementation and 51 statements were formulated as a result. Finally, all HCPs were asked to validate and to quantify these statements and to formulate recommendations for further adoption.ResultsThe majority of respondents said that training of all HCPs is essential. Feedback on consultation and peer observation are considered to help improve performance. In addition, HCPs stated that SDM should also be embedded in multidisciplinary meetings, whereas implementation in the organisation could be facilitated by appointed ambassadors. Time was not seen as an inhibiting factor. According to HCPs, negotiating patients’ treatment decisions improves adherence to therapy. Despite possible cognitive or communications issues, all are convinced patients with stroke can be involved in a SDM-process. Relatives play an important role too in the further adoption of SDM. HCPs provided eight recommendations for adoption of SDM in integrated stroke care.ConclusionsHCPs in our study indicated it is feasible to implement SDM in integrated stroke care and several well-known implementation activities could improve SDM in stroke care. Special attention should be given to the following activities: (1) the appointment of knowledge brokers, (2) agreements between HCPs on roles and responsibilities for specific decision points in the integrated stroke care chain and (3) the timely investigation of patient’s preferences in the care process – preferably before starting treatment through discussions in a multidisciplinary meeting.

Fatores facilitadores e barreiras ao trabalho em equipe para atendimento hospitalar de acidente vascular cerebral

“…Quanto às barreiras para o trabalho inter ou multidisciplinar, evidenciamos como principais, a falta de tempo (Johnson et al, 2015;Singh et al, 2015;Plant & Tyson, 2018) e falta de envolvimento de membros da equipe (Plant & Tyson et al, 2018) para esse tipo de intervenção. Esses fatores afetam o estabelecimento de metas para a tomada de decisão da equipe e isso se torna ainda mais importante, ao verificar em estudos recentes que o próprio funcionamento da equipe também é influenciado por processos que incluem a tomada de decisão (Voogdt-Pruis, 2019;Kilpatrick et al, 2020).…”

Patient Pathways During Acute in-Hospital Stroke Treatment: A Qualitative Multi-Method Study

“…Integrated care interventions for stroke have primarily focussed on problems in the post-acute phases of care such as transitioning from the hospital to care provision in the community or primary care setting. Examples described in the literature include “silo-based” care provision, lack of integration between sectors, limited access to specialists, gaps in care transitions and discharge planning as well as insufficient patient involvement, shared decision-making and self-management support [ 15 16 17 18 19 ]. However, even within hospitals, stroke care is extremely complex and fragmentation regularly occurs at various points along the pathway.…”

Understanding the Professional Care Experience of Patients with Stroke: A Qualitative Study Using In-Depth Interviews

“…Integrated care of the stroke patient should be based on collaborative engagement and cooperation between patients and caregivers to align health care services resulting in effective clinical stroke care management [ 5 ]. It is necessary to favor the implementation of this integrated care in stroke patients by facilitating the management of patient preferences in the care process [ 6 ], requiring rigorous evaluation in this population through training and patient empowerment of their health care [ 7 ]. The patient’s perspective on their health care affects adherence to treatment or the reduction of complaints and is considered a proxy indicator of care [ 8 ].…”