The Hospital-Wide Implementation of Shared Decision-Making

Abstract

The German Law on Patients' Rights (Patientenrechtegesetz) stipulates that all medically reasonable treatment options must be taken into consideration by the physician and the patient, in the light of the best available medical evidence and the patient's preferences, so that a decision on treatment can be jointly taken. The method known as shared decision-making (SDM) is the gold standard (1).As a model for the universal implementation of SDM, the Innovation Fund of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) currently supports the SHARE TO CARE (S2C) program, in which SDM is to be implemented in every clinical department on the Kiel campus at the University Medical Center Schleswig-Holstein (UKSH) (2).The UKSH neurology department is the first organizational unit in which the S2C program has been fully implemented. The present study addresses the practical implementability of the S2C program and its effectiveness in making shared decision-making a reality. MethodsThe four intervention modules of the S2C program, which were previously validated in randomized, controlled trials (2), involve the main stakeholders in the hospital:• All doctors undergo online training and receive individual feedback on video recordings of their own conversations with patients, instructing them how they can effectively bring about SDM.

Major influencing factors on routine implementation of shared decision-making in cancer care: qualitative process evaluation of a stepped-wedge cluster randomized trial

“…A recent implementation study on SDM in breast cancer care that used a co-design approach found effects in observer-assessed SDM uptake, but also no effects in patient-reported SDM [ 21 ]. In addition, another multi-component implementation trial from Germany has a strong focus on developing disease-specific patient decision aids together with clinical partners also reported and was able to temporarily allocate clinical departments’ work force resources to the development of these [ 19 , 46 ]. This trial found significant effects on SDM uptake in preliminary results from one department and reported a reach of over 90% [ 46 ].…”

Teaching communication skills in medical education

“…This international initiative has developed brief recommendations for various specialities to reduce overuse and misuse. In Germany, a corresponding program for all clinics and departments has been established at the UKSH in Kiel as a national competence center for shared decision-making [ 8 ]. All physicians (> 90% of each clinic) underwent a multistage training program to improve communication for doctor–patient contacts.…”

‘A good decision is the one that feels right for me’: Codesign with patients to inform theoretical underpinning of a decision aid website

“…[5][6][7][8][9] Resources are stretched, limiting time in clinic for 'collaborative deliberation' 10 and consent-taking for complex decisions, 11 although general principles, strategies and evidence communication guidelines can be helpful. [12][13][14] There are encouraging examples of successful implementation with dedicated funding, training and support from political and healthcare systems, [15][16][17] resulting in improved satisfaction, cost-and time-savings and redress of the traditional power imbalance in patient-provider relationships. SDM is worthy of the required effort from patients and clinicians as 'a method of creating the best care… also the human, kind and caring thing to do'.…”