Objective: To prioritize strategies to implement shared decision-making (SDM) in daily practice, resulting in an agenda for a nationwide approach.
Methods: This was a qualitative, exploratory investigation involving: Interviews (N = 43) to elicit perceived barriers to and facilitators of change, focus group discussions (N = 51) to develop an implementation strategy, and re-affirmation through written feedback (n = 19). Professionals, patients, researchers and policymakers from different healthcare sectors participated. Determinants for change were addressed at four implementation levels: (1) the concept of SDM, (2) clinician and/or patient, (3) organizational context and (4) socio-political context.
Results: Following the identification of perceived barriers, four strategies were proposed to scale up SDM: 1) stimulating intrinsic motivation among clinicians via an integrated programmatic approach, 2) training and implementation in routine practice, 3) stimulating the empowerment of patients, 4) creating an enabling socio-political context.
Conclusion: Clinicians mentioned that applying SDM makes their job more rewarding and indicated that implementation in daily practice needs ground-up redesign. The challenge is to effectively influence the behavior of clinicians and patients alike, and adapt clinical pathways to facilitate the exploration of patient values.
Practice implications: Stakeholders should connect nationwide initiatives to pool information, and make the healthcare system supportive of implementing SDM. (C) 2018 Elsevier B.V. All rights reserved.
|Number of pages||8|
|Journal||Patient Education and Counseling|
|Publication status||Published - Dec 2018|
- Shared decision-making
- Patient-centered care
- Practice improvement
- EVIDENCE-BASED MEDICINE