Population Health, Faculty of Health Sciences; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
CHEO and CHEO Research Institute.
Acad Pediatr. 2019 Jan-Feb;19(1):118-129. doi: 10.1016/j.acap.2018.05.010. Epub 2018 Jun 1.
To assess barriers to and facilitators of shared decision making (SDM) for pediatric healthcare providers (HCPs) after they have been trained in SDM.
A mixed methods study using triangulation of data sources. Pediatric HCPs with SDM training who worked at a Canadian tertiary care pediatric hospital were eligible. Participants completed a validated SDM barriers survey (n = 60) and a semi-structured interview (n = 11). We calculated descriptive statistics. Univariate and multivariable ordinary least squares linear regression models determined predictors of HCPs' intention to use SDM. Interviews were audiotaped and transcribed verbatim. We analyzed qualitative data using deductive and inductive content analyses and organized categories according to the Ottawa Model of Research Use.
Intention to use SDM was high (mean score = 5.6/7, SD = 0.78) and positively correlated with SDM use (RR = 1.46, 95% CI 1.18-1.81). However, 52% of survey respondents reported not using SDM after training. HCPs identified factors influencing SDM at the levels of innovation, adopter, environment, and training. Insufficient time (barrier) and buy-in and agreement with SDM (facilitators) were most commonly cited. To improve SDM use, HCPs want a more team-based approach to SDM training, continuing education, and implementation.
Despite training and positive intentions, many HCPs report not subsequently using SDM and identified numerous post-training barriers to its use. To overcome SDM barriers and improve uptake, HCPs recommend creating a socially supportive environment through a team-based approach to SDM training and implementation. These findings can inform SDM training and implementation interventions at pediatric health care centers.
评估在儿科医疗保健提供者（HCP）接受共享决策制定（SDM）培训后，实施 SDM 的障碍和促进因素。
本研究采用混合方法研究，对数据来源进行三角测量。具有 SDM 培训的加拿大三级儿科医院工作的儿科 HCP 符合纳入标准。参与者完成了一项经过验证的 SDM 障碍调查（n=60）和半结构化访谈（n=11）。我们计算了描述性统计数据。单变量和多变量普通最小二乘线性回归模型确定了 HCP 使用 SDM 的意愿的预测因素。访谈进行了录音，并逐字转录。我们使用演绎和归纳内容分析对定性数据进行分析，并根据渥太华研究利用模型对类别进行了组织。
使用 SDM 的意愿很高（平均得分=5.6/7，SD=0.78），并与 SDM 的使用呈正相关（RR=1.46，95%CI 1.18-1.81）。然而，52%的调查受访者报告在培训后未使用 SDM。HCP 确定了影响创新、采用者、环境和培训各个层面 SDM 的因素。时间不足（障碍）和对 SDM 的认同和一致（促进因素）是最常被引用的。为了提高 SDM 的使用，HCP 希望在 SDM 培训、继续教育和实施方面采用更具团队合作的方法。
尽管接受了培训并表现出积极的意愿，但许多 HCP 报告在培训后并未继续使用 SDM，并且在使用 SDM 方面还存在许多障碍。为了克服 SDM 障碍并提高其使用率，HCP 建议通过团队合作的方式来进行 SDM 培训和实施，从而创造一个支持性的社会环境。这些发现可以为儿科医疗保健中心的 SDM 培训和实施干预措施提供信息。
