National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany.
BMJ Evid Based Med. 2024 Mar 21;29(2):87-95. doi: 10.1136/bmjebm-2023-112462.
To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM).
Pre-post study.
University Hospital Schleswig-Holstein (UKSH), Kiel Campus.
Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH.
The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate.
In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICS). Pre-post comparisons were done using t-tests.
The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICS showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects.
The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
评估 SHARE TO CARE（S2C）计划的可行性和有效性，该计划是为在全院范围内实施共享决策（SDM）而设计的复杂干预措施。
前后研究。
石勒苏益格-荷尔斯泰因大学医院（UKSH），基尔校区。
来自 UKSH 基尔校区 22 个科室的医疗保健专业人员以及住院患者和门诊患者。
S2C 计划是一项全面的实施策略，包括四个核心模块：（1）医生培训，（2）护士作为决策教练的 SDM 支持培训和支持，（3）患者激活，（4）基于证据的患者决策辅助工具的开发和整合到患者路径中。全面实施后，科室将获得 S2C 证书。
在本文中，我们报告了实施的可行性和有效性结果。可行性通过方案四个模块的实施程度来判断。有效性的结果测量是患者报告的体验测量（PREMs）。有效性的主要结果测量是参与护理量表（PICS）的患者决策子量表。使用 t 检验进行前后比较。
在研究时间框架内，22 个纳入科室中有 18 个完成了 S2C 计划四个组成部分的实施。实施完成后，与基线相比，PICS 的平均值显示出统计学上的显著差异（p<0.01）。这一差异对应于小到中等但具有临床意义的积极影响（Hedges'g=0.2）。与此一致的是，次要 PREMs（决策准备和 collaboRATE）也显示出具有统计学意义和临床意义的积极效果。
在项目时间框架内，通过 S2C 计划在全院范围内实施 SDM 被证明是可行且有效的。德国联邦联合委员会已建议将基尔 SDM 模式作为国家护理标准。
