Ariadne Labs, Harvard School of Public Health, Boston, Massachusetts, USA.
Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Birth. 2022 Sep;49(3):440-454. doi: 10.1111/birt.12611. Epub 2022 Jan 7.
Shared decision-making (SDM) may improve communication, teamwork, patient experience, respectful maternity care, and safety during childbirth. Despite these benefits, SDM is not widely implemented, and strategies for implementing SDM interventions are not well described. We assessed the acceptability and feasibility of TeamBirth, an SDM solution that centers the birthing person in decision-making through simple tools that structure communication among the care team. We identified and described implementation strategies that bridge the gap between knowledge and practice.
We conducted a qualitative study among four hospitals in the United States to understand the acceptability and feasibility of TeamBirth. We interviewed 103 clinicians and conducted 16 focus group discussions with 52 implementers between June 2018 and October 2019. We drew on the Consolidated Framework for Implementation Research to understand acceptability and feasibility, and to identify and describe the underlying contextual factors that affected implementation.
We found that clinicians and implementers valued TeamBirth for promoting clarity about care plans among the direct care team and for centering the birthing person in decision-making. Contextual factors that affected implementation included strength of leadership, physician practice models, and quality improvement culture. Effective implementation strategies included regular data feedback and adapting "flexible" components of TeamBirth to the local context.
By identifying and describing TeamBirth's contextual factors and implementation strategies, our findings can help bridge the implementation gap of SDM interventions. Our in-depth analysis offers tangible lessons for other labor and delivery unit leaders as they seek to integrate SDM practices in their own settings.
共享决策（SDM）可以改善沟通、团队合作、患者体验、尊重产妇护理以及分娩期间的安全性。尽管有这些好处，但 SDM 并未广泛实施，并且实施 SDM 干预措施的策略也没有得到很好的描述。我们评估了 TeamBirth 的可接受性和可行性，这是一种通过简单的工具使分娩者成为决策中心的 SDM 解决方案，这些工具可以在护理团队之间构建沟通结构。我们确定并描述了缩小知识与实践差距的实施策略。
我们在美国的四家医院进行了一项定性研究，以了解 TeamBirth 的可接受性和可行性。我们采访了 103 名临床医生，并在 2018 年 6 月至 2019 年 10 月期间进行了 16 次焦点小组讨论，共有 52 名实施者参加。我们借鉴了实施研究综合框架来了解可接受性和可行性，并确定和描述影响实施的潜在背景因素。
我们发现，临床医生和实施者认为 TeamBirth 有助于促进直接护理团队之间的护理计划清晰，并使分娩者成为决策中心。影响实施的背景因素包括领导力、医生实践模式和质量改进文化。有效的实施策略包括定期数据反馈和调整 TeamBirth 的“灵活”部分以适应当地情况。
通过确定和描述 TeamBirth 的背景因素和实施策略，我们的研究结果可以帮助缩小 SDM 干预措施的实施差距。我们的深入分析为其他分娩单位领导提供了具体的经验教训，因为他们在寻求将 SDM 实践融入自己的环境时。
