Towards a taxonomy of behavior change techniques for promoting shared decision making

Abstract

Background There is little information about the functions and behavior change techniques (BCTs) needed to implement shared decision making (SDM) in clinical practice. To guide future implementation initiatives, we sought to develop a BCT taxonomy for SDM implementation interventions. Methods This study is a secondary analysis of a 2018 Cochrane review on interventions for increasing the use of shared decision making by healthcare professionals. We examined all 87 studies included in the review. We extracted relevant information on each study intervention into a spreadsheet. Coders had undergone a training workshop on intervention functions and online training on BCT Taxonomy version 1 (BCTTv1). We performed functions and BCTs coding trials, and identified coding rules. We used Michie’s guide for designing behavior change interventions to code the functions and BCTs used in the interventions. Coders met to compare coding and discrepancies were discussed until consensus was reached. Data was analyzed using simple descriptive statistics. Results Overall, 7 functions, 24 combinations of functions and 32 BCTs were used in the 87 SDM implementation interventions. The mean of functions per intervention was 2.5 and the mean of BCTs per intervention was 3.7. The functions Coercion and Restriction were not found. The most common function was Education (73 studies). Three combinations of functions were most common (e.g: Education + Persuasion, used in 10 studies). The functions associated with more effective SDM implementation interventions were Modeling and Training. The most effective combination of functions was Education + Training + Modeling + Enablement. The most commonly used BCT was Instruction on how to perform the behavior (43 studies). BCTs associated with more effective SDM implementation interventions were: Instruction on how to perform the behavior, Demonstration of the behavior, Feedback on behavior, Pharmacological support, Material reward, and Biofeedback. Twenty-five BCTs were associated with less effective SDM implementation interventions. Four new BCTs were identified: General information to support the behavior, Tailoring, Exercises to conceptually prepare for the behavior, and Experience sharing and learning. Conclusions We established a BCT taxonomy specific to the field of SDM to guide future SDM implementation interventions. Four new BCTs should be added to BCTTv1.

A systematic review of shared decision making interventions in child and youth mental health: synthesising the use of theory, intervention functions, and behaviour change techniques

“…Overall, 18 out of 93 possible behaviour change techniques were identified in SDM interventions in child and youth mental health. This is less than the 32 found in the previous review [29]; however, as the previous review did not limit itself to any specific presenting difficulty nor population, a wider range of behaviour change techniques may be expected.…”

Practitioners’ views on shared decision-making implementation: A qualitative study

“…Evidence from the Center shows that between two groups of clinicians who had received SDM training, the level of patient engagement and SDM measured by OPTION scores was significantly higher when a PDA was used [ 11 ]. This suggests that while training on its own may improve clinicians’ knowledge and skills to an extent, the repetition of using the five-step PDA may help solidify the contents of the training till it becomes routine [ 39 ]. There is preliminary evidence of PDAs being used as ‘scaffolding’ to facilitate SDM consultations, and certain PDA formats such as decision cards are specifically designed to function as collaborative tools rather than purely information tools [ 40 , 41 ].…”

Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process

“…6 The implementation of SDM in clinical practice, however, remains suboptimal. [7][8][9] Clinician-reported barriers to applying SDM include time constraints and the perceived incapability of patients to participate in decision making. 10 Advancing the implementation of SDM is also hindered by clinicians' perception that they already practise SDM.…”