Milestones, barriers and beacons: Shared decision making in Canada inches ahead

Stacey, Dawn; Forest, Pierre-Gerlier; Coutu, Marie‐France; Archambault, Patrick; Boland, Laura; Witteman, Holly O.; LeBlanc, Annie; Lewis, Krystina B.; Giguère, Anik

doi:10.1016/j.zefq.2017.05.020

Cited by 17 publications

(21 citation statements)

References 21 publications

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“…An expert panel (AMCG, EF-B, DC) developed a preliminary list of 11 items, in French, based on a review of the literature about the barriers perceived by clinicians to adopt SDM. 19,20,[24][25][26][27][28][29][30][31] Facilitators were not included as they almost all have a barrier counterpart. The panel selected the barriers most often reported and wrote them as affirmative statements (Table 1).…”

Section: Item Formulationmentioning

confidence: 99%

Development of the IcanSDM scale to assess primary care clinicians’ ability to adopt shared decision-making

Giguère

Bogza

Coudert³

et al. 2020

Preprint

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Introduction: Implementation of shared decision making (SDM) remains a challenge. To support implementation studies, we sought to develop and validate the IcanSDM scale that assesses clinicians' perceptions of their ability to adopt SDM. Methods: An expert panel reviewed the literature on clinician-reported barriers to SDM adoption, to create an 11-item preliminary scale. A convenience sample of 16 clinicians from Quebec (Canada) completed the IcanSDM and the Belief about Capabilities subscale of the CPD-Reaction instrument (BCap), before and after SDM training. We audio-recorded their comments as they completed the scale. We measured IcanSDM's internal consistency, sensitivity to change and correlation with BCap. Partial correlation coefficients and item analyses suggested removing three items. We then tested the 8-item IcanSDM with a new sample of 17 clinicians. Results: In the 11-item IcanSDM version, three items lacked clarity or responsiveness, or showed negative partial correlations with the whole instrument. We thus removed these items. The revised 8-item version gave Cronbach's alphas of 0.63 before and 0.71 after training, and a 16% improvement in IcanSDM total score after training, compared to before training (p<0.0001). We also found a significant correlation between IcanSDM and the BCap before training (p=0.02), but not after (p=0.46). Discussion: IcanSDM is the only instrument measuring this construct. It could thus help bridge the gap in our ability to understand the determinants of clinicians' SDM behavior intentions and thus help improve SDM implementation impacts and efforts. IcanSDM requires testing with a larger sample to confirm its responsiveness.

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Section: Item Formulationmentioning

confidence: 99%

Development of the IcanSDM scale to assess primary care clinicians’ ability to adopt shared decision-making

Giguère

Bogza

Coudert³

et al. 2020

Preprint

Self Cite

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“…In these countries, SDM is being established at a policy level, and system-wide implementation strategies with leadership and financial support have been developed. [14][15][16][17][18][19][20] Interventions tested and implemented in these countries include communication and marketing, patient and public involvement, research, training, legislation, access to PDAs, service provision, clinical champions, financial incentives and policy [14][15][16][17][18][19] (Table 4).…”

Section: International Reviewmentioning

confidence: 99%

“…Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus 7,[14][15][16][17][18][19][20] For NSW Health, the high number of participant responses coded to the theoretical domain 'environmental context and resources' suggests the importance of attending to organisational culture and ensuring resources are available to support the use of SDM in clinical practice.…”

Section: Skillsmentioning

confidence: 99%

Shared decision making implementation: a case study analysis to increase uptake in New South Wales

Dimopoulos-Bick¹,

Osten²,

Shipway³

et al. 2019

Aust. Health Rev.

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The aim of this study was to identify potential implementation interventions to increase the uptake of shared decision making (SDM) in clinical practice in New South Wales (NSW) Health. The Agency for Clinical Innovation hosted a full-day SDM masterclass in May 2017 and 53 attendees completed a survey to identify barriers to implementing SDM. The Theoretical Domains Framework, COM-B ('capability', 'opportunity', motivation' and 'behaviour') Model and Behaviour Change Wheel were used to conduct a theoretical analysis of the barriers and identify potential interventions to increase the uptake of SDM. This was supplemented by a purposive review of articles about current international efforts to facilitate SDM. From the theoretical analysis, 9 of the 14 theoretical domains were considered relevant to implementing SDM in the NSW Health context. Multi-faceted interventions including education, training, enablement, modelling, incentivisation, persuasion and environmental restructuring were identified as potential ways to increase SDM. The review of international articles identified communication and marketing, patient and public involvement, research, training, legislation, patient decision aids, service provision, clinical champions, financial incentives and policy as interventions being used to increase the uptake of SDM internationally. Based on current perceptions about barriers for SDM implementation in NSW Health, initial efforts should focus on workforce skills development, motivation, communication and marketing, service provision and creating receptive work environments. Investments into facilitating SDM will require an ongoing commitment to enhancing patient experience, evidence translation and reducing unwarranted variations in care.

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“…In light of this study, one may consider treating these patients with a removable ankle stirrup and return to activities as tolerated. However, as the long-term safety of this treatment has not been established, shared decision-making with parents 3,4,5 as to the risks and benefits of a stirrup brace versus casting may be appropriate to determine the definitive treatment.…”

Section: Clinical Bottom Linementioning

confidence: 99%