Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

Danner, Marion; Geiger, Friedemann; Wehkamp, Kai; Rueffer, Jens Ulrich; Kuch, Christine; Sundmacher, Leonie; Skjelbakken, Tove; Rummer, Anne; Novelli, Anna; Debrouwere, Marie; Scheibler, Fueloep

doi:10.1136/bmjopen-2020-037575

Cited by 35 publications

(46 citation statements)

References 47 publications

(54 reference statements)

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“…Regarding patient decision aids and information material, it was not part of this trial to develop new decision aids as other implementation studies or studies with hybrid effectiveness-implementation designs [ 72 ] do (e.g. [ 73 ],). When systematically screening for evidence-based decision aids in German language for cancer-related decisions within this trial, the lack of such material became apparent.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

et al. 2021

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Background Shared decision-making (SDM) is preferred by many patients in cancer care. However, despite scientific evidence and promotion by health policy makers, SDM implementation in routine health care lags behind. This study aimed to evaluate an empirically and theoretically grounded implementation program for SDM in cancer care. Methods In a stepped wedge design, three departments of a comprehensive cancer center sequentially received the implementation program in a randomized order. It included six components: training for health care professionals (HCPs), individual coaching for physicians, patient activation intervention, patient information material/decision aids, revision of quality management documents, and reflection on multidisciplinary team meetings (MDTMs). Outcome evaluation comprised four measurement waves. The primary endpoint was patient-reported SDM uptake using the 9-item Shared Decision Making Questionnaire. Several secondary implementation outcomes were assessed. A mixed-methods process evaluation was conducted to evaluate reach and fidelity. Data were analyzed using mixed linear models, qualitative content analysis, and descriptive statistics. Results A total of 2,128 patient questionnaires, 559 questionnaires from 408 HCPs, 132 audio recordings of clinical encounters, and 842 case discussions from 66 MDTMs were evaluated. There was no statistically significant improvement in the primary endpoint SDM uptake. Patients in the intervention condition were more likely to experience shared or patient-lead decision-making than in the control condition (d=0.24). HCPs in the intervention condition reported more knowledge about SDM than in the control condition (d = 0.50). In MDTMs the quality of psycho-social information was lower in the intervention than in the control condition (d = − 0.48). Further secondary outcomes did not differ statistically significantly between conditions. All components were implemented in all departments, but reach was limited (e.g., training of 44% of eligible HCPs) and several adaptations occurred (e.g., reduced dose of coaching). Conclusions The process evaluation provides possible explanations for the lack of statistically significant effects in the primary and most of the secondary outcomes. Low reach and adaptations, particularly in dose, may explain the results. Other or more intensive approaches are needed for successful department-wide implementation of SDM in routine cancer care. Further research is needed to understand factors influencing implementation of SDM in cancer care. Trial registration clinicaltrials.gov, NCT03393351, registered 8 January 2018.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

et al. 2021

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“…The concept of this and several other EbPDAs developed within the SDM implementation program SHARE TO CARE is very similar. 25 The common subject employs the three questions (ASK3, sometimes also referred to as “three good questions” or similar) that improve the quality of health communication on medical decisions: what are my options? What are the benefits and harms?…”

Section: Discussionmentioning

confidence: 99%

“…The digital decision aid used in this study was developed as part of the implementation program for shared decision-making “SHARE TO CARE”, which also includes other modules, eg, online and face-to-face training of physicians and interventions to empower patients. 25 All modules apply an identical, plain six-step model of SDM, which refers to the “essential elements of SDM”. 26 The didactics and content of the digital evidence-based patient decision aid (EbPDA) apply the International Patient Decision Aid Standards (IPDAS).…”

Section: Methodsmentioning

confidence: 99%

“…In the EbPDA for hypertension that was deployed in this study, the decision tool was based on the ARRIBA-method, an interactive risk-calculator and decision-making instrument for cardiovascular events. 29,30 The provided medical content is based on a systematic review of current evidence for antihypertensive therapies.- 25 It is presented with written, graphical, and video-based information, featuring interactive elements to illustrate the relation of personal preferences, possible choices, and experiences of affected patients, physicians, and related healthcare workers. 31 The complete EbPDA is peerreviewed by medical and scientific experts and underwent user-testing by laypeople.…”

Section: Study Design Participants and Randomizationmentioning

confidence: 99%

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Enhancing Specific Health Literacy with a Digital Evidence-Based Patient Decision Aid for Hypertension: A Randomized Controlled Trial

Wehkamp¹,

Kiefer²,

Geiger³

et al. 2021

PPA

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Introduction Health literacy is an important competency to make informed, shared decisions in line with patient’s preferences. On the other hand, lower health literacy is associated with poorer health outcomes. Evidence-based patient decision aids (EbPDA) are validated instruments to support informed medical decisions and empower patients for relevant involvement in their care. This study aimed to investigate the effect of a digital EbPDA for hypertension on health literacy. Methods In a randomized controlled trial, 124 participants were presented with a web-based scenario related to a newly diagnosed condition of arterial hypertension. The intervention group was provided with an online decision aid, while the control group was prompted to search for related information without support. Specific health literacy for hypertension was operationalized based on the European survey for health literacy (HLS-EU-Q47). Results The intervention group showed a statistically significant increase in subjectively perceived overall specific health literacy regarding hypertension (p=0.02, Cohen’s d=0.44). The effect was also statistically significant for the subcategories understanding, appraising, and applying health-related information (all p<0.05). At least equal results could be shown for participants with a lower level of education compared to participants with a high level. Conclusion The findings suggest that digital EbPDAs can be an effective and easily scalable instrument to improve populations’ specific health literacy. A possible advantage of the measure could be that patients are addressed concerning important and pressing personal decisions, fostering awareness of the individual’s need for health literacy to reflect one’s options and preferences. EbPDAs may also be a promising approach to target vulnerable populations, as the investigated EbPDA seems to perform equally in less versus more educated individuals. For future research, it may be interesting to investigate whether EbPDAs have effects on general health literacy that go beyond the disease specifically addressed.

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“…SDM is a process in which clinicians and patients work together to select tests, treatments, and management or support packages based on clinical evidence and the patient's informed preferences. It involves the provision of evidence-based information about options, outcomes, and uncertainties, together with decision support counseling and a system for recording and implementing patients' informed preferences (1). It was developed in the mental health field in response to the reality that psychiatric medications come in a package with varying degrees of benefits and risks.…”

Section: Introductionmentioning

confidence: 99%

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Ismail

Midin

2021

Front. Psychiatry

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Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia.Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses.Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = −0.33, 95% CI = −0.67 to −0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39–30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72–0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10–7.82).Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.

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Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

Cited by 35 publications

References 47 publications

Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

Enhancing Specific Health Literacy with a Digital Evidence-Based Patient Decision Aid for Hypertension: A Randomized Controlled Trial

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

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