Centre for Research on Health and Social Care Management (CeRGAS), SDA Bocconi School of Management, Milan, 20136, Italy.
BMC Med Inform Decis Mak. 2023 Aug 23;23(1):164. doi: 10.1186/s12911-023-02263-8.
Shared decision-making (SDM) is a collaborative process whereby patients and clinicians jointly deliberate on the best treatment option that takes into account patients' preferences and values. In breast cancer care, different treatment options have become available to patients in the last decade. Various interventions, including patient decision aids (PtDAs), have been designed to promote SDM in this disease area. This study aimed at investigating the factors that influence the successful adoption and implementation of SDM interventions in real-world healthcare delivery settings.
A scoping review of scientific and grey literature was conducted for the period 2006-2021 to analyse the support for SDM interventions and their adoption in breast cancer clinical practice. The interpretation of findings was based on the Practical, Robust Implementation and Sustainability Model (PRISM) for integrating research findings into practice.
Overall, 19 studies were included for data synthesis, with more than 70% published since 2017. The availability of SDM tools does not automatically translate into their actual use in clinical settings. Factors related to users' co-creation, the clinical team's attitude and knowledge, organisational support and regulatory provisions facilitate the adoption of SDM interventions. However, overlooking aspects such as the re-organisation of care pathways, patient characteristics, and assigning of resources (human, financial, and facilities) can hinder implementation efforts.
Compared to the mounting evidence on the efficacy of SDM interventions, knowledge to support their sustained implementation in daily care is still limited, albeit results show an increasing interest in strategies that facilitate their uptake in breast cancer care over time. These findings highlight different strategies that can be used to embed SDM interventions in clinical practice. Future work should investigate which approaches are more effective in light of organisational conditions and external factors, including an evaluation of costs and healthcare system settings.
共同决策（SDM）是一个协作过程，在此过程中，患者和临床医生共同讨论考虑到患者偏好和价值观的最佳治疗方案。在乳腺癌护理中，过去十年中为患者提供了不同的治疗选择。各种干预措施，包括患者决策辅助工具（PtDAs），旨在促进该疾病领域的 SDM。本研究旨在调查影响 SDM 干预措施在实际医疗保健环境中成功采用和实施的因素。
对 2006-2021 年期间的科学和灰色文献进行了范围审查，以分析对 SDM 干预措施的支持及其在乳腺癌临床实践中的采用。研究结果的解释基于实用、稳健实施和可持续性模型（PRISM），该模型将研究结果整合到实践中。
总体而言，纳入了 19 项研究进行数据综合，其中超过 70%的研究是在 2017 年之后发表的。SDM 工具的可用性并不能自动转化为其在临床环境中的实际使用。与用户共同创造、临床团队的态度和知识、组织支持和监管规定相关的因素促进了 SDM 干预措施的采用。然而，忽视了护理路径的重新组织、患者特征以及资源（人力、财务和设施）的分配等方面可能会阻碍实施工作。
与 SDM 干预措施的功效不断增加的证据相比，支持其在日常护理中持续实施的知识仍然有限，尽管结果表明随着时间的推移，越来越关注促进其在乳腺癌护理中采用的策略。这些发现强调了可以在临床实践中嵌入 SDM 干预措施的不同策略。未来的工作应该根据组织条件和外部因素，包括对成本和医疗保健系统设置的评估，研究哪些方法更有效。
