Alberta Health Services, Calgary, Canada.
Integrative Health Institute, University of Alberta, Edmonton, Canada.
Health Soc Care Community. 2022 May;30(3):1051-1063. doi: 10.1111/hsc.13304. Epub 2021 Apr 6.
Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.
患者为中心的护理和患者参与医疗保健和健康研究已被广泛授权给供资方、医疗系统和机构。越来越多的人认识到共同决策（SDM）可以促进以患者为中心的护理。我们通过研究在社区康复中整合新的以患者为中心的政策的背景下的共同决策来探索这种关系。在康复领域，关于共同决策的研究很少，在关键的社区背景下就更少了。患者共同研究者领导了研究的共同设计。我们旨在描述在采用新的以患者为中心的康复护理模式（RMoC）的社区康复机构中，患者和提供者如何体验共同决策。在集中民族志的指导下，我们进行了焦点小组和访谈。从 10 个 RMoC 早期采用社区康复的地点招募了患者和专业人员。这些地点在地理位置、患者群体和提供专业人员的学科方面存在差异。患者和社区参与研究人员使用一套收集-反思方法来记录患者的观点。研究人员使用半结构化问题指南记录提供者的观点。我们完成了 11 个焦点小组和 18 次访谈（n=45 名提供者，n=17 名患者）。我们发现，大多数早期采用者的提供者都以一种共同的、以患者为中心的语言进行交流，重点是患者的准备情况、障碍和积极倾听。一致的患者认知反映了在决策、目标设定和积极关系中的参与。许多患者在社区康复护理之前和之后都分别询问了护理将如何变得和保持可及性。患者认为在社区中保持联系很重要。提供者确定了一些障碍，例如时间、团队动态以及对 RMoC 目标的理解不明确，这些障碍挑战了该倡议的长期可持续性。政策创新可以通过多种策略和培训来促进坦率、鼓舞人心的对话，从而促进共同决策和沟通。共同决策成果的可持续性至关重要。大多数提供者已经超越了象征性的参与，但竞争的责任和团队成员的抵制可能会破坏连续性。需要进一步研究以从实证角度评估社区康复中长期的尊重和富有同情心的沟通和共同决策。
