Center for Shared Decision Making, Department of Clinical Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark.
Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
PLoS One. 2023 Jan 24;18(1):e0280547. doi: 10.1371/journal.pone.0280547. eCollection 2023.
Shared decision making (SDM) is a core element in the meeting between patient and healthcare professionals, but has proved difficult to implement and sustain in routine clinical practice. One of five Danish regions set out to succeed and to develop a model that ensures lasting SDM based on learnings from large-scale real-world implementation initiatives that go beyond the 'barriers' and 'facilitators' research approach. This paper describes this process and development of a generic implementation model, SDM:HOSP.
This project was carried out in the Region of Southern Denmark with five major hospital units. Based on existing theory of SDM, SDM implementation, implementation science and improvement methodology, a process of four phases were described; development of conceptual elements, field-testing, evaluation, and development of the final implementation model. The conceptual elements developed aimed to prepare leaders, train SDM teachers, teach clinicians to perform SDM, support development of patient decision aids, and support systematic planning, execution and follow-up. Field testing was done including continuous participant evaluations and an overall evaluation after one year.
Data from field testing and learnings from the implementation process, illustrated the need for a dynamic and easy adjustable model. The final SDM:HOSP model included four themes; i)Training of Leaders, ii) Training of Teachers and Clinicians, iii) Decision Helper, and iv) 'Process', each with details in three levels, 1) shared elements, 2) recommendations, and 3) local adaption.
A feasible and acceptable model for implementation of SDM across hospitals and departments that accounts for different organizations and cultures was developed. The overall design can easily be adapted to other organizations and can be adjusted to fit the specific organization and culture. The results from the ongoing and overall evaluation suggest promising avenues for future work in further testing and research of the usability of the model.
共同决策（SDM）是医患会议的核心要素，但在常规临床实践中实施和维持共同决策证明具有挑战性。丹麦五个地区之一决心取得成功，并开发一种模型，该模型基于从超越“障碍”和“促进者”研究方法的大规模现实实施举措中获得的经验，确保持久的 SDM。本文描述了这一过程以及通用实施模型 SDM：HOSP 的开发。
该项目在丹麦南部地区的五个主要医院单位进行。基于现有的 SDM 理论、SDM 实施、实施科学和改进方法，描述了四个阶段的过程；概念要素的开发、现场测试、评估和最终实施模型的开发。开发的概念要素旨在为领导者提供准备、培训 SDM 教师、培训临床医生进行 SDM、支持患者决策辅助的开发以及支持系统规划、执行和跟进。现场测试包括持续的参与者评估和一年后的总体评估。
现场测试数据和实施过程中的经验教训表明，需要一个动态且易于调整的模型。最终的 SDM：HOSP 模型包括四个主题；i）领导者培训，ii）教师和临床医生培训，iii）决策助手，iv）“流程”，每个主题都包含三个级别细节：1）共享要素，2）建议，3）本地调整。
开发了一种可行且可接受的跨医院和部门实施 SDM 的模型，该模型考虑了不同的组织和文化。总体设计可以轻松适应其他组织，并可以根据特定的组织和文化进行调整。正在进行和总体评估的结果表明，该模型的可用性的进一步测试和研究具有广阔的前景。
