Qualitative Examination of Shared Decision-Making in Canada’s Largest Health System: More Work to be Done

Abstract

Background: Shared Decision-Making (SDM) is an inclusive approach where patients and providers work in partnership to make health care decisions that are grounded in clinical best practice and align with patient preferences and values. Despite a growing recognition that SDM can lead to improved outcomes and reductions in unnecessary health investigations, tensions exist between patient agency and a historically paternalistic model of health care. As an evolving ideology, the Research Team sought to better understand the current state, challenges, and implementation opportunities of SDM practices across the health system. Methods: This study used a cross-sectional quality improvement design utilizing semistructured interviews to gather information from focus group participants. Five open-ended, qualitative questions were used to generate discussion on the perceptions of SDM and its role in clinical appropriateness in a variety of clinical contexts in our health system. A total of 12 focus groups (n = 95 participants) representative of patients and families, leaders, physicians, and frontline clinicians were engaged in the study. Results: Through a consensus-based approach, study results identified 4 recommendations based on 4 themes: Time, Communication, System Design, and Clinical Appropriateness. Conclusion: There are no easy solutions to the challenges of enabling SDM; however, success will be dependent upon recognizing the importance of patient agency, while maintaining an inclusive and continuous stakeholder engagement with both patients and providers. Implementation of the 4 recommendations at the organizational level highlighted in this study can serve as a road map for other health care institutions and will require a gradual approach to transform the general principles of SDM into tangible solutions to meet the emerging needs at both the local and system level.

Is it fun or is it hard? Studying physician-related attributes of shared decision-making by ranking case vignettes

“…Although promising as a concept and despite supportive measures like decision aids and training in decision-making, implementing SDM has been a laborious, challenging and time-consuming process [ [6] , [7] , [8] ]. Moreover, SDM utilization is perceived as incomplete or inconclusive [ [9] , [10] , [11] ], even though advice on overcoming obstacles for successful implementation seems readily available [ 8 , 12 , 13 ]. Therefore, whether previous studies on (surmounting) barriers to implementation have considered all crucial determinants for success remains to be debated.…”