Bonfils Kelsey A, Dreison Kimberly C, Luther Lauren, Fukui Sadaaki, Dempsey Abigail E, Rapp Charles A, Salyers Michelle P
Department of Psychology, Indiana University-Purdue University Indianapolis.
School of Social Welfare Center for Mental Health Research and Innovation, University of Kansas.
Psychiatr Rehabil J. 2018 Sep;41(3):216-223. doi: 10.1037/prj0000225. Epub 2016 Oct 10.
Although shared decision making (SDM) is a key element of client-centered care, it has not been widely adopted. Accordingly, interventions have been developed to promote SDM. The aim of this study was to explore the implementation process of one SDM intervention, CommonGround, which utilizes peer specialists and a computerized decision support center to promote SDM.
As part of a larger study, CommonGround was implemented in 4 treatment teams in a community mental health center. The implementation process was examined by conducting semistructured interviews with 12 staff members that were integral to the CommonGround implementation. Responses were analyzed using content analysis. Program fidelity and client program use were also examined.
Although key informants identified several client and staff benefits to using CommonGround, including improved treatment engagement and availability of peer specialists, most clients did not use CommonGround consistently throughout the implementation. Key informants and fidelity reports indicated a number of program (e.g., technological difficulties, increased staff burden) and contextual barriers (e.g., poor fit with service structure, decision support center location, low staff investment and high turnover) to the successful implementation of CommonGround. Strategies to maximize the implementation by increasing awareness, buy-in, and utilization are also reported.
This implementation of CommonGround was limited in its success partly as a result of program and contextual barriers. Future implementations may benefit from incorporating the strategies identified to maximize implementation in order to obtain the full program benefits. (PsycINFO Database Record
尽管共同决策（SDM）是以患者为中心的护理的关键要素，但尚未得到广泛采用。因此，已开发出干预措施来促进共同决策。本研究的目的是探讨一种共同决策干预措施“共同基础”（CommonGround）的实施过程，该措施利用同伴专家和计算机化决策支持中心来促进共同决策。
作为一项更大规模研究的一部分，“共同基础”在一家社区心理健康中心的4个治疗团队中实施。通过对12名对“共同基础”实施至关重要的工作人员进行半结构化访谈来考察实施过程。使用内容分析法对回答进行分析。还检查了项目保真度和患者对项目的使用情况。
尽管关键信息提供者指出使用“共同基础”对患者和工作人员有诸多益处，包括改善治疗参与度和同伴专家的可及性，但在实施过程中，大多数患者并未持续使用“共同基础”。关键信息提供者和保真度报告指出了“共同基础”成功实施的一些项目障碍（如技术困难、工作人员负担加重）和背景障碍（如与服务结构不匹配、决策支持中心位置、工作人员投入低和高流动率）。还报告了通过提高认识、获得支持和利用率来最大化实施的策略。
“共同基础”的此次实施成功有限，部分原因是项目和背景障碍。未来的实施可能会受益于纳入已确定的最大化实施的策略，以便获得该项目的全部益处。（PsycINFO数据库记录）
