Bowen Deborah J, Nguyen Ann M, LeRouge Cynthia, LePoire Erin, Sheng Kwan-Gett Tao
Department of Bioethics and Humanities, School of Medicine, University of Washington, 1959 NE Pacific St., Room A204, Box 357120, Seattle, WA 98195, USA.
Rutgers Center for State Health Policy, 112 Paterson St., 5th Floor, New Brunswick, NJ 08901, USA.
Healthcare (Basel). 2021 Sep 16;9(9):1217. doi: 10.3390/healthcare9091217.
As healthcare systems progress toward initiatives that increase patient engagement, stakeholder hopes are that shared decision making (SDM) will become routine practice. Yet, there is limited empirical evidence to guide such SDM program implementations, particularly in obstetric practices. The first stage of any project implementation is the "initiation stage", in which project leaders define a project's purpose and stakeholders and structures are put in place to support the new initiative. Our study's objective was to identify factors affecting the initiation stage of an SDM program implementation project for TOLAC, trial of labor after Cesarean. We conducted a multiple-case study of an SDM program implementation in three obstetric settings in Washington State. The research design and analysis were guided by implementation science frameworks and project management literature. Data sources included interviews with key informants from the State, SDM tool vendors, and three project sites, as well as implementation documents. The study results provide insight into how the identified project implementation factors provide an essential foundation for informing project planning, execution, and reflection/evaluation. In this study, the State's decision aid certification program pressured the project sites to shape the project purpose and engage stakeholders that would meet immediate project requirements (specifically, state requirements). The study reveals that external demands may not be in perfect alignment with the internal necessities required for an SDM program's long-term viability and sustainability. Findings may be used by implementers and researchers to model and strategize the early stages of SDM program implementation projects, particularly in the obstetric setting.
随着医疗保健系统朝着提高患者参与度的举措迈进，利益相关者希望共享决策（SDM）将成为常规做法。然而，指导此类SDM项目实施的实证证据有限，尤其是在产科实践中。任何项目实施的第一阶段都是“启动阶段”，在这个阶段，项目负责人确定项目的目的，并建立利益相关者和结构以支持新举措。我们研究的目的是确定影响剖宫产术后阴道试产（TOLAC）的SDM项目实施项目启动阶段的因素。我们对华盛顿州三个产科环境中的SDM项目实施进行了多案例研究。研究设计和分析以实施科学框架和项目管理文献为指导。数据来源包括对来自该州、SDM工具供应商和三个项目地点的关键信息提供者的访谈，以及实施文件。研究结果提供了关于已确定的项目实施因素如何为项目规划、执行和反思/评估提供重要基础的见解。在本研究中，该州的决策辅助认证计划迫使项目地点确定项目目的，并让符合项目即时需求（特别是州要求）的利益相关者参与进来。研究表明，外部需求可能与SDM项目长期可行性和可持续性所需的内部必要性不完全一致。实施者和研究人员可以利用这些发现来为SDM项目实施项目的早期阶段建模并制定策略，尤其是在产科环境中。
