Müller Evamaria, Hahlweg Pola, Scholl Isabelle
a Department of Medical Psychology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
Acta Oncol. 2016 Dec;55(12):1484-1491. doi: 10.1080/0284186X.2016.1227087. Epub 2016 Sep 8.
Shared decision making (SDM) is particularly relevant in oncology, where complex treatment options with varying side effects may lead to meaningful changes in the patient's quality of life. For several years, health policies have called for the implementation of SDM, but SDM remains poorly implemented in routine clinical practice. Implementation science has highlighted the importance of assessing stakeholders' needs to inform the development of implementation programs. Thus, the aim of the present study was to assess different stakeholders' needs regarding the implementation of SDM in routine care.
A qualitative study using focus groups and interviews was conducted. Focus groups were carried out with junior physicians, senior physicians, nurses and other healthcare providers (HPCs) (e.g. psycho-oncologists, physiotherapists), patients and family members. Head physicians as well as other HPCs in management positions were interviewed. Audiotapes of focus groups and interviews were transcribed verbatim and analyzed using content analysis.
Six focus groups with a total of n = 42 stakeholders as well as n = 17 interviews were conducted. Focus groups and interviews revealed five main categories of needs to be fulfilled in order to achieve a better implementation of SDM in routine cancer care: 1) changes in communication, 2) involvement of other parties, 3) a trustful patient-physician relationship, 4) culture change and 5) structural changes. Stakeholders discussed four clusters of intervention strategies that could foster the implementation of SDM in routine cancer care: 1) clinician-mediated interventions, 2) patient-mediated interventions, 3) provision of patient information material and 4) the establishment of a patient advocate.
Study results show that stakeholders voiced a diversity of needs to foster implementation of SDM in routine cancer care, of which some can be directly addressed by intervention strategies. Present results can be used to develop an implementation program to foster SDM in routine cancer care.
共同决策（SDM）在肿瘤学中尤为重要，因为具有不同副作用的复杂治疗方案可能会导致患者生活质量发生显著变化。多年来，卫生政策一直呼吁实施共同决策，但在日常临床实践中，共同决策的实施情况仍然很差。实施科学强调了评估利益相关者需求对实施计划制定的重要性。因此，本研究的目的是评估不同利益相关者在日常护理中实施共同决策方面的需求。
采用焦点小组和访谈进行定性研究。与初级医生、高级医生、护士和其他医疗服务提供者（HPCs）（如心理肿瘤学家、物理治疗师）、患者及其家属进行了焦点小组讨论。对主任医师以及担任管理职位的其他HPCs进行了访谈。焦点小组讨论和访谈的录音逐字转录，并使用内容分析法进行分析。
共进行了6个焦点小组讨论，共有n = 42名利益相关者参与，以及n = 17次访谈。焦点小组讨论和访谈揭示了为了在日常癌症护理中更好地实施共同决策需要满足的五个主要需求类别：1）沟通方式的改变；2）其他各方的参与；3）医患之间的信任关系；4）文化变革；5）结构变革。利益相关者讨论了四类干预策略，这些策略可以促进共同决策在日常癌症护理中的实施：1）临床医生介导的干预措施；2）患者介导的干预措施；3）提供患者信息材料；4）设立患者代言人。
研究结果表明，利益相关者表达了在日常癌症护理中促进共同决策实施的各种需求，其中一些需求可以通过干预策略直接解决。目前的研究结果可用于制定一项在日常癌症护理中促进共同决策的实施计划。
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