Lessons in Integrating Shared Decision-Making Into Cancer Care

Abstract

The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark's Lillebaelt Hospital, in creating The Patient's Cancer Hospital in Vejle, has learned key lessons in implementing SDM so that the organization's culture is actually being transformed. In short, SDM is becoming part of the fabric of care, not a mere add-on to it. Specifically, the hospital chose and structured its leadership to ensure that SDM is constantly championed. It organized multiple demonstration projects focused on use of decision aids, patient-reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution's SDM initiatives from the Danish national annual survey of patients' experiences show substantial progress, thereby motivating Lillebaelt to reassert its commitment to the effort, to share what it has learned, and to invite dialogue among all cancer care organizations as they seek to fully integrate SDM in daily clinical practice.

The impact of a patient decision aid on shared decision‐making behaviour in oncology care and pulmonary medicine—A field study based on real‐life observations

“…To test feasibility and to investigate to what extent the PtDA improved SDM, it was applied in the second phase of the beta test, and validated quantitative questionnaires were used to evaluate the results . The PtDA template is described elsewhere …”

“…24 The PtDA template is described elsewhere. 23,25 Observations were performed in two different departments. (a)…”

Cross-sectoral video consultations in cancer care: perspectives of cancer patients, oncologists and general practitioners

“…Concerning the generalisability of study results, it is important to acknowledge the strategic work that has already been done at the trial hospital. The hospital has been known for years as being innovative regarding cross-sectoral cooperation [42], shared decision-making [43] and patient-centred communication [44]. Therefore, the oncologist may be more open-minded towards sharing knowledge and decisions with GPs, and more focused on communication and patient involvement than oncologists in general.…”

A prospective cohort study of shared decision making in lung cancer diagnostics: Impact of using a patient decision aid

“…SDM is a clinical process in which clinicians and patients make appropriate health decisions together based on clinical evidence and patient preferences. SDM is developed for clinical situations with great ambiguity as well as severe consequences and has proven to facilitate patient involvement (10)(11)(12)(13)(14)(15)(16). SDM may increase patient involvement by making the patient comfortable in taking active part in decision making in situations where there is more than one option and one is not clearly better than the other.…”