Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, ZA, The Netherlands.
Implement Sci. 2013 Aug 23;8:95. doi: 10.1186/1748-5908-8-95.
The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.
We conducted 40 semi-structured interviews with professionals involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons) and three focus groups among patients (six to eight per group). The interviews and focus groups were audiotaped and transcribed in full. Reported barriers and facilitators were classified according to the framework of Grol and Wensing. The software package Atlas.ti 7.0 was used for analysis.
Professionals reported 53 barriers and 5 facilitators, and patients 35 barriers and 18 facilitators for SDM in sciatica care. Professionals perceived most barriers at the level of the organizational context, and facilitators at the level of the individual professional. Patients reported most barriers and facilitators at the level of the individual professional. Several barriers and facilitators correspond with barriers and facilitators found in the literature (e.g., lack of time, motivation) but also new barriers and facilitators were identified. Many of these new barriers mentioned by both professionals and patients were related to the multidisciplinary setting, such as lack of visibility, lack of trust in expertise of other disciplines, and lack of communication between disciplines.
This study identified barriers and facilitators for SDM in the multidisciplinary sciatica setting, by both professionals and patients. It is clear that more barriers than facilitators are perceived for implementation of SDM in sciatica care. Newly identified barriers and facilitators are related to the multidisciplinary care setting. Therefore, an effective implementation strategy of SDM in a multidisciplinary setting such as in sciatica care should focus on these barriers and facilitators.
荷兰多学科坐骨神经痛指南建议参与坐骨神经痛治疗的专业团队和患者共同决定手术或长期保守治疗（共同决策[SDM]）。尽管有此建议，但 SDM 尚未整合到坐骨神经痛治疗中。现有的关于 SDM 实施障碍和促进因素的文献主要仅关注一个学科，而多学科护理可能涉及其他障碍和促进因素，或者使专业人员和患者更难处理这些障碍和促进因素。因此，这项定性研究旨在确定患者和专业人员认为在多学科坐骨神经痛护理中实施 SDM 的障碍和促进因素。
我们对参与坐骨神经痛治疗的专业人员（全科医生、物理治疗师、神经科医生、神经外科医生和骨科医生）进行了 40 次半结构化访谈，并在患者中进行了三个焦点小组（每组六到八人）。访谈和焦点小组被完整地录音并转录。根据 Grol 和 Wensing 的框架对报告的障碍和促进因素进行了分类。使用 Atlas.ti 7.0 软件包进行分析。
专业人员报告了 53 个 SDM 在坐骨神经痛护理中的障碍和 5 个促进因素，患者报告了 35 个障碍和 18 个促进因素。专业人员在组织背景层面上感知到大多数障碍，而在个人专业层面上感知到大多数促进因素。患者在个人专业层面上报告了大多数障碍和促进因素。一些障碍和促进因素与文献中发现的障碍和促进因素相对应（例如，缺乏时间、缺乏动机），但也发现了一些新的障碍和促进因素。专业人员和患者都提到了许多新障碍，这些障碍大多与多学科环境有关，例如缺乏可见性、对其他学科专业知识的信任缺失以及学科之间缺乏沟通。
本研究通过专业人员和患者确定了多学科坐骨神经痛环境中 SDM 的障碍和促进因素。很明显，在坐骨神经痛护理中实施 SDM 感知到的障碍多于促进因素。新识别的障碍和促进因素与多学科护理环境有关。因此，在多学科环境中（如在坐骨神经痛护理中）实施 SDM 的有效策略应重点关注这些障碍和促进因素。
