Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation. Issue 12 (December 2018)

• Record Type: Journal Article
• Authors: van Veenendaal, Haske; van der Weijden, Trudy; Ubbink, Dirk T.; Stiggelbout, Anne M.; van Mierlo, Linda A.; Hilders, Carina G.J.M.
• Is Part Of: Patient education and counseling. Volume 101:Issue 12(2018)
• Page Start: 2097
• Page End: 2104
• Publication Date: 2018-12
• Subjects: Shared decision-making -- Implementation -- Patient-centered care -- Practice improvement -- Multilevel; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2018.06.021
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Effective implementation of SDM should start bottom-up to align with each clinical context. Effectively engaging physicians is critical to making SDM part of usual care. Adapting clinical pathways and clinician and patient behavior is key to implementation. At the national level, fragmented but promising initiatives should be coordinated. Abstract: 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.