Haske van Veenendaal1, Trudy van der Weijden2, Dirk T Ubbink3, Anne M Stiggelbout4, Linda A van Mierlo5, Carina G J M Hilders6. 1. Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. Electronic address: haskevanveenendaal@gmail.com. 2. Department of Family Medicine, CAPHRI, Maastricht University Medical Centre, PO Box 616, 6200 MD, Maastricht, The Netherlands. Electronic address: trudy.vanderweijden@maastrichtuniversity.nl. 3. Department of Surgery, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. Electronic address: d.ubbink@amc.nl. 4. Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Post zone J10-S, Postbus 9600, 2300 RC, Leiden, The Netherlands. Electronic address: a.m.stiggelbout@lumc.nl. 5. Department of Innovation, CZ Healthcare Insurance, Postbus 90152, 5000 LD, Tilburg, The Netherlands. Electronic address: lindavanmierlo@hotmail.com. 6. Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands; Board of directors, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands. Electronic address: c.hilders@rdgg.nl.
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.
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.
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