van Veenendaal Haske, Voogdt-Pruis Helene R, Ubbink Dirk T, van Weele Esther, Koco Lejla, Schuurman Maaike, Oskam Jannie, Visserman Ella, Hilders Carina G J M
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands; UMCU Julius Global Health, PO box 85500, 3508 GA Utrecht, Netherlands.
Patient Educ Couns. 2022 Jan;105(1):114-127. doi: 10.1016/j.pec.2021.05.005. Epub 2021 May 11.
Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians.
The program was based on the 'Measurement Instrument for Determinants of Innovations-model' (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews.
Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued.
Our program supported breast cancer clinicians to adopt SDM.
To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
评估一项针对乳腺癌临床医生的共享决策（SDM）多层次实施计划。
该计划基于“创新决定因素测量工具模型”（MIDI）。纳入了有效实施的关键因素。从两个地理区域挑选了11个乳腺癌治疗团队参与；首先是6个外科手术团队，其次是5个全身治疗团队。在每个阶段结束时进行了混合方法评估：调查采用描述性统计，半结构化访谈采用主题内容分析。
28名临床医生返回了问卷（42%）。临床医生（96%）认可共享决策与乳腺癌护理相关。该计划支持在他们的实践中采用共享决策。经常报告的障碍包括资金手段有限、时间限制和并行活动。访谈（n = 21）表明，使用一个4步共享决策模型——当通过实际例子、便捷卡片、反馈和培训加以强化时——有助于将共享决策理论内化。临床医生对患者和他们自己都取得了积极的成果。任务重新分配和灵活的门诊规划强化了可持续的改变。患者的参与受到重视。
我们的计划支持乳腺癌临床医生采用共享决策。
为了实施共享决策，需要采用多层次方法，通过展示对患者和临床医生的益处来强化内在动机。
