Blum Livnat, Jarach Carlotta Micaela, Ellen Moriah E
Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
Laboratory of Lifestyle Research, Department of Medical Epidemiology, Mario Negri Institute of Pharmacological Research, IRCCS, Italy.
Patient Educ Couns. 2023 Oct;115:107877. doi: 10.1016/j.pec.2023.107877. Epub 2023 Jun 28.
Shared decision-making (SDM) is the partnership and discussion between clinicians and patients to make an appropriate decision based on scientific evidence and patient preferences. Many benefits are associated with SDM; however, little is known about its awareness or use by inflammatory bowel disease (IBD) clinicians in gastroenterology departments across Israel. This study aims to identify barriers and facilitators in implementing SDM as standard practice to achieve optimal disease management and personalized care for patients with IBD.
Sixteen semi-structured interviews were conducted with IBD clinicians across Israel to identify the barriers and facilitators for SDM use. An interview guide was developed, based on the systematic approach of the Theoretical Domain Framework (TDF). Interview transcripts were coded into theoretical domains to identify factors that may impact SDM.
Sixteen gastroenterologists from nine different hospitals were interviewed. Common TDF domains that presented as barriers were: knowledge, skills, social/professional role and identity, environmental context and resources, and reinforcement. Most participants had never heard the precise term "shared decision making" and lacked formal training on SDM.
This study identified key barriers and facilitators to SDM in IBD clinics across Israel. Main barriers of SDM include limited or nonexistent training; clinicians were unaware of SDM guidelines or techniques. The main facilitators of SDM were clinicians' social and professional role and identity and their beliefs about the influence of IBD and/or CD.
These influencing factors and TDF domains identified provide a basis for developing future interventions to improve the implementation of SDM within IBD management.
共同决策（SDM）是临床医生与患者之间的合作与讨论，旨在基于科学证据和患者偏好做出恰当决策。共同决策有诸多益处；然而，以色列各地胃肠病科的炎症性肠病（IBD）临床医生对其认知或使用情况却知之甚少。本研究旨在确定将共同决策作为标准做法以实现IBD患者最佳疾病管理和个性化护理过程中的障碍与促进因素。
对以色列各地的IBD临床医生进行了16次半结构化访谈，以确定使用共同决策的障碍与促进因素。基于理论领域框架（TDF）的系统方法制定了访谈指南。访谈记录被编码到各个理论领域，以确定可能影响共同决策的因素。
对来自9家不同医院的16名胃肠病学家进行了访谈。呈现为障碍的常见TDF领域包括：知识、技能、社会/职业角色与身份、环境背景与资源以及强化。大多数参与者从未听过“共同决策”这个确切术语，并且缺乏关于共同决策的正规培训。
本研究确定了以色列各地IBD诊所共同决策的关键障碍与促进因素。共同决策的主要障碍包括培训有限或根本没有培训；临床医生不了解共同决策指南或技术。共同决策的主要促进因素是临床医生的社会和职业角色与身份以及他们对IBD和/或克罗恩病影响的信念。
所确定的这些影响因素和TDF领域为制定未来干预措施提供了基础，以改善IBD管理中共同决策的实施情况。
