Status report from Norway: Implementation of patient involvement in Norwegian health care

Abstract

Norway has traditionally high standards regarding civil rights particularly emphasizing equal access to societal resources including health care. This background and the health care system's centralized national organization make it perfectly suited for implementation of shared decision making (SDM). In recent years, great efforts have been made by policy- makers, regional health authorities and not least the patients to facilitate a process of change in health communication culture. SDM is currently even given highest priority in health care strategies on all system levels. SDM has been structurally implemented, e.g. by including corresponding guidance in the standard patient pathways. Moreover, SDM is established as an element of service on the national health portal hosting a constantly increasing number of decision aids. Essentially the Norwegian Knowledge Center for Health Services contributes by searching and providing information for use in decision aids. Implementation is now being rolled out unit by unit for a list of medical problems as a series production of SDM using decision aids and health professional training. Importantly, production of SDM begins and succeeds as a soundly structured communication with both clinical environments and patients. However, as communication training has not been implemented before now, there are no data demonstrating sufficient realization of SDM in current health care. Beyond making reasonable use of scientific achievements, the Norwegian movement's secret of success is the simultaneous commitment of all actors of the health system to a common idea.

Ready for shared decision making: Pretesting a training module for health professionals on sharing decisions with their patients

“…The strategy is meant to be adaptive to the current status of implementation of SDM in Norway; therefore, the study focused on feasibility rather than efficacy of the SDM training. 18 As recently shown in a German study, 23 a programme might prove efficient, but due to lacking feasibility nevertheless fail to demonstrate effectiveness. To keep a realistic chance of making an impact on the health system, a training needs to be adaptable to various settings and timeframes.…”

“…The increasing number of patient decision aids both internationally and in Norway [33][34][35] should be complemented by a national effort to systematically implement SDM training. 18 As we continue to develop the "Ready for SDM" training, we will consider designing further studies in accordance with the complex intervention framework and the Kirkpatrick's model. 12 This study has only evaluated the first two levels of the Kirkpatrick's model, but the intention is to make changes based on these findings and evaluate the other levels.…”

“…This training has been developed as part of a more comprehensive strategy to implement SDM in the Norwegian health system. The strategy is meant to be adaptive to the current status of implementation of SDM in Norway; therefore, the study focused on feasibility rather than efficacy of the SDM training …”

“…Level and objectives were adjusted to the actual stage of implementation in Norway and were considered responsive to HCPs current needs and a meaningful first step to approach a higher level of training using complementary modules such as doktormitSDM.…”

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

“…9 The Norwegian 'Decision Aid (DA) Factory' approach of the University Hospital North Norway, in which researchers and developers of SDM components-so-called 'knowledge producers'-work in close cooperation with the physicians and patients-so-called 'knowledge users'inspired implementation processes in this project. 10 Individual components of SDM such as SDM training for healthcare professionals, patient activation/empowerment programmes or decision aids have all been previously tested in specific indications, populations and using different study designs. [11][12][13][14][15] Their effectiveness and impact on decision processes have been assessed.…”