Lillebaelt Hospital, Vejle; The Danish Cancer Society, Copenhagen; Design School Kolding, Kolding, Denmark; University of Oxford, Oxford, United Kingdom; Coalition to Transform Advanced Care, Washington, DC; Advanced Care Innovation Strategies, Forestville, CA; Texas A&M University, College Station, TX; and Institute for Healthcare Improvement, Cambridge, MA.
J Oncol Pract. 2018 Apr;14(4):229-235. doi: 10.1200/JOP.18.00019.
The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark's Lillebaelt Hospital, in creating The Patient's Cancer Hospital in Vejle, has learned key lessons in implementing SDM so that the organization's culture is actually being transformed. In short, SDM is becoming part of the fabric of care, not a mere add-on to it. Specifically, the hospital chose and structured its leadership to ensure that SDM is constantly championed. It organized multiple demonstration projects focused on use of decision aids, patient-reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution's SDM initiatives from the Danish national annual survey of patients' experiences show substantial progress, thereby motivating Lillebaelt to reassert its commitment to the effort, to share what it has learned, and to invite dialogue among all cancer care organizations as they seek to fully integrate SDM in daily clinical practice.
共享决策（SDM）在医疗保健中的益处已得到充分证明，但在机构层面实施 SDM 具有挑战性，特别是当患者患有复杂疾病和护理需求时，如癌症。丹麦的 Lillebaelt 医院在创建 Vejle 的 The Patient's Cancer Hospital 时，汲取了在实施 SDM 方面的关键经验教训，从而使组织文化得到了真正的转变。简而言之，SDM 正在成为护理的一部分，而不仅仅是附加的。具体来说，该医院选择并构建了领导层，以确保 SDM 不断得到拥护。它组织了多个专注于使用决策辅助工具、患者报告的结果测量、更好的沟通工具和实践的示范项目。它设计了培训临床医生医患沟通技巧的计划。它利用研究证据为其临床医生与患者使用的决策辅助工具的开发提供信息。它还以持续的方式严格衡量 SDM 的绩效，以便跟踪和改进进展，以确保持续改进。来自丹麦全国年度患者体验调查的关于该机构 SDM 计划的初步数据显示取得了实质性进展，从而促使 Lillebaelt 重申其对这一努力的承诺，分享其所学的知识，并邀请所有癌症护理组织进行对话，因为他们正在寻求将 SDM 完全融入日常临床实践。
