Waddell Alex, Goodwin Denise, Spassova Gerri, Bragge Peter
Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia.
Safer Care Victoria, Victorian Department of Health, Melbourne, VIC, Australia.
MDM Policy Pract. 2023 Sep 22;8(2):23814683231199943. doi: 10.1177/23814683231199943. eCollection 2023 Jul-Dec.
It is a patient's right to be included in decisions about their health care. Implementing shared decision making (SDM) is important to enable active communication between clinicians and patients. Although health policy makers are increasingly mandating SDM implementation, SDM adoption has been slow. This study explored stakeholders' organizational- and system-level barriers and facilitators to implementing policy mandated SDM in maternity care in Victoria, Australia. Twenty-four semi-structured interviews were conducted with participants including clinicians, health service administrators and decision makers, and government policy makers. Data were mapped to the Theoretical Domains Framework to identify barriers and facilitators to SDM implementation. Factors identified as facilitating SDM implementation included using a whole-of-system approach, providing additional implementation resources, correct documentation facilitated by electronic medical records, and including patient outcomes in measurement. Barriers included health service lack of capacity, unclear policy definitions of SDM, and policy makers' lack of resources to track implementation. This is the first study to our knowledge to explore barriers and facilitators to SDM implementation from the perspective of multiple actors following policy mandating SDM in tertiary health services in Australia. The primary finding was that there are concerns that SDM implementation policy is outpacing practice. Nonclinical staff play a crucial role translating policy to practice. Addressing organizational- and system-level barriers and facilitators to SDM implementation should be a key concern of health policy makers, health services, and staff.
New government policies require shared decision making (SDM) implementation in hospitals.There is limited evidence for how to implement SDM in hospital settings.There are concerns SDM implementation policy is outpacing practice.Understanding and capacity for SDM varies considerably among stakeholders.Whole of system approaches and electronic medical records are seen to facilitate SDM.
患者有权参与有关其医疗保健的决策。实施共同决策（SDM）对于促进临床医生与患者之间的积极沟通至关重要。尽管卫生政策制定者越来越多地强制要求实施SDM，但SDM的采用速度一直很慢。本研究探讨了利益相关者在澳大利亚维多利亚州产科护理中实施政策强制要求的SDM时，在组织和系统层面遇到的障碍及促进因素。对包括临床医生、卫生服务管理人员和决策者以及政府政策制定者在内的参与者进行了24次半结构化访谈。数据被映射到理论领域框架，以确定SDM实施的障碍和促进因素。确定为促进SDM实施的因素包括采用全系统方法、提供额外的实施资源、电子病历便于正确记录以及在衡量中纳入患者结果。障碍包括卫生服务能力不足、SDM的政策定义不明确以及政策制定者缺乏跟踪实施情况的资源。据我们所知，这是第一项从多个行为者的角度探讨在澳大利亚三级卫生服务中政策强制要求SDM实施的障碍和促进因素的研究。主要发现是人们担心SDM实施政策的速度超过了实践。非临床工作人员在将政策转化为实践方面起着关键作用。解决SDM实施的组织和系统层面的障碍及促进因素应是卫生政策制定者、卫生服务机构和工作人员的主要关注点。
新的政府政策要求在医院实施共同决策（SDM）。关于如何在医院环境中实施SDM的证据有限。人们担心SDM实施政策的速度超过了实践。利益相关者对SDM的理解和能力差异很大。全系统方法和电子病历被认为有助于实施SDM。
