"SDM:HOSP"- a generic model for hospital-based implementation of shared decision making

Development and testing of a generic patient decision aid for end-of-life care

OBJECTIVES

The objective of this study was to develop and test a patient decision aid for end-of-life care to be used when some or all life-sustaining treatments have been withheld or withdrawn.

METHODS

A multi-professional, multi-sectorial group together with patients and relatives used a systematic process to develop and test the patient decision aid, including alpha and beta testing.

RESULTS

Healthcare professionals, patients and relatives were involved in the development and testing. The final Decision Helper included three areas with nine options: follow-up (outpatient clinic and general practitioner), palliative care (primary care, specialised palliative care team, hospital admission and hospice) and treatment level (intensive care, resuscitation attempt and nutrition via feeding tube). Most participants agreed that the amount of information in the Decision Helper was appropriate, that it clearly presented benefits and disadvantages and that it was useful in the value clarification process, helping to verbalise preferences and what is most important for patients.

CONCLUSIONS

Most patients and healthcare professionals found that the decision aid would be helpful in facilitating shared decision-making in an end-of-life conversation.

PRACTICE IMPLICATIONS

The decision aid will be usable in different healthcare setting ensuring that end-of-life care is in accordance with patients' wishes.

"Developing the tool SDM:KOMPASS. Supporting shared decision making implementation processes"

Shared decision-making (SDM) involves patients in choosing their treatment or care options. SDM enhances patient engagement and treatment satisfaction. SDM has proved difficult to implement and sustain in routine clinical practice, hence a supportive tool is needed. This quality improvement study focuses on the development of a generic tool, labeled SDM:KOMPASS, which is intended to support hospital settings by facilitating the visualization of their formative progress and the setting of goals for the SDM implementation into routine clinical practice. The main objective of the present paper is to describe the development of this generic tool. A six-step development process was performed to develop a tool and investigate the tool's overall perceived usability. Qualitative methods, such as observations, individual and focus group interviews, provided insights. A 10-item quantitative survey gauged informants' immediate attitudes towards the tool. Purposefully sampled informants (N = 20), including healthcare professionals and patients, contributed diverse perspectives regarding; 1) The tool's readability and clarity, 2) the construct's domains and content, and 3) the tool's perceived usability. In alignment with real-world challenges, SDM:KOMPASS emerges as a potentially valuable resource for healthcare organizations embedding SDM. The six-step development process revealed how the tool SDM:KOMPASS has potential to enhance SDM implementation's manageability, goal-setting, and focus. Professionals engaged in strategic implementation within somatic and mental hospital departments find the tool potentially beneficial and feasible. The tool shows promise and usability but requires careful attention due to its comprehensiveness. The next step is to alpha test the tool in clinical practice.

Measuring healthcare professionals' perceptions of their ability to adopt shared decision making: Translation and psychometric evaluation of the Danish version of the IcanSDM questionnaire

BACKGROUND

Shared  decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties.

METHODS

Cultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness.

RESULTS

The forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM_Danish obtained a Cronbach's alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant.

CONCLUSION

The IcanSDM_Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM_Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact.

Barriers and facilitators of healthcare professionals in integrating shared decision-making in pancreatic cancer treatment: A network approach

PURPOSE

Shared decision-making (SDM) is crucial in pancreatic cancer treatment due to its choice-sensitive nature and limited prognosis. Treatment of pancreatic cancer is organized in a network approach. Several obstacles exist on different levels-patient, healthcare professional, organizational, societal-that impede integration of SDM. This study aims to identify barriers and facilitators to SDM implementation within a comprehensive cancer network.

METHODS

A qualitative research design was applied, involving interviews and focus groups on barriers and facilitators with healthcare professionals involved in the implementation of SDM. In one comprehensive cancer network in the Netherlands, including seven hospitals, a project was initiated with the goal of empowering patients and healthcare professionals in SDM throughout primary, secondary and tertiary healthcare settings. A total of 17 participants were assessed. Directed qualitative content analysis was performed by two researchers.

RESULTS

Main findings revealed barriers such as time constraints, lack of priority of physicians, little involvement of general practitioners, and insufficient social context of patients in referrals, alongside facilitators including learning communities with practical SDM examples, metro mapping, involvement of case manager in implementation and patient empowerment strategies.

CONCLUSION

Addressing cultural, systemic barriers and developing innovative strategies are of importance to enhance SDM in pancreatic cancer treatment in a network approach. This study provides understanding of SDM implementation in complex healthcare settings and offers valuable guidance for future interventions seeking to improve decision-making processes in pancreatic cancer treatment and beyond.

Shared decision making with breast cancer patients - does it work? Results of the cluster-randomized, multicenter DBCG RT SDM trial

BACKGROUND AND PURPOSE

Shared decision making (SDM) is a patient engaging process advocated especially for preference-sensitive decisions, such as adjuvant treatment after breast cancer. An increasing call for patient engagement in decision making highlights the need for a systematic SDM approach. The objective of this trial was to investigate whether the Decision Helper (DH), an in-consultation patient decision aid, increases patient engagement in decisions regarding adjuvant whole breast irradiation.

MATERIAL AND METHODS

Oncologists at four radiotherapy units were randomized to practice SDM using the DH versus usual practice. Patient candidates for adjuvant whole breast irradiation after breast conserving surgery for node-negative breast cancer were eligible. The primary endpoint was patient-reported engagement in the decision process assessed with the Shared Decision Making Questionnaire (SDM-Q-9) (range 0-100, 4 points difference considered clinical relevant). Other endpoints included oncologist-reported patient engagement, decisional conflict, fear of cancer recurrence, and decision regret after 6 months.

RESULTS

Of the 674 included patients, 635 (94.2%) completed the SDM-Q-9. Patients in the intervention group reported higher level of engagement (median 80; IQR 68.9 to 94.4) than the control group (71.1; IQR 55.6 to 82.2; p < 0.0001). Oncologist-reported patient engagement was higher in the invention group (93.3; IQR 82.2 to 100) compared to control group (73.3; IQR 60.0 to 84.4) (p < 0.0001).

CONCLUSION

Patient engagement in medical decision making was significantly improved with the use of an in-consultation patient decision aid compared to standard. The DH on adjuvant whole breast irradiation is now recommended as standard of care in the Danish guideline.

Impact of timing and format of patient decision aids for breast cancer patients on their involvement in and preparedness for decision making - the IMPACTT randomised controlled trial protocol

BACKGROUND

After curative surgery for early-stage breast cancer, patients face a decision on whether to undergo surgery alone or to receive one or more adjuvant treatments, which may lower the risk of recurrence. Variations in survival outcomes are often marginal but there are differences in the side effects and other features of the options that patients may value differently. Hence, the patient's values and preferences are critical in determining what option to choose. It is well-researched that the use of shared decision making and patient decision aids can support this choice in a discussion between patient and clinician. However, it is still to be investigated what impact the timing and format of the patient decision aid have on shared decision making outcomes. In this trial, we aim to investigate the impact of a digital pre-consult compared to a paper-based in-consult patient decision aid on patients' involvement in shared decision making, decisional conflict and preparedness to make a decision.

METHODS

The study is a randomised controlled trial with 204 patients at two Danish oncology outpatient clinics. Eligible patients are newly diagnosed with early-stage breast cancer and offered adjuvant treatments after curative surgery to lower the risk of recurrence. Participants will be randomised to receive either an in-consult paper-based patient decision aid or a pre-consult digital patient decision aid. Data collection includes patient and clinician-reported outcomes as well as observer-reported shared decision making based on audio recordings of the consultation. The primary outcome is the extent to which patients are engaged in a shared decision making process reported by the patient. Secondary aims include the length of consultation, preparation for decision making, preferred role in shared decision making and decisional conflict.

DISCUSSION

This study is the first known randomised, controlled trial comparing a digital, pre-consult patient decision aid to an identical paper-based, in-consult patient decision aid. It will contribute evidence on the impact of patient decision aids in terms of investigating if pre-consult digital patient decisions aids compared to in-consult paper-based decision aids support the cancer patients in being better prepared for decision making.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05573022).