Wurhofer Daniela, Neunteufel Julia, Strumegger Eva-Maria, Höppchen Isabel, Mayr Barbara, Egger Andreas, Sareban Mahdi, Reich Bernhard, Neudorfer Michael, Niebauer Josef, Smeddinck Jan David, Kulnik Stefan Tino
Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.
University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria.
Front Digit Health. 2024 Jan 4;5:1324488. doi: 10.3389/fdgth.2023.1324488. eCollection 2023.
Shared decision making (SDM) between healthcare professionals and persons with CVD can have a positive impact on motivation, adherence, or sustainability regarding long-term goals and integration of cardiovascular disease (CVD) rehabilitation in the everyday lives of persons with CVD. SDM can foster the transition between regular heart-healthy activity at rehabilitation facilities and more independent activity at home, but it is often challenging to implement SDM given limited time and resources, e.g., in the daily practice of rehabilitation. Digital tools can help but must be appropriately tailored for situated use and user needs.
We aimed to (1) describe in how far SDM is manifested in the situated context when using a digital tool developed by our group, and, based on that, (2) reflect on how digital health tools can be designed to facilitate and improve the SDM process.
In the context of a field study, we investigated how SDM is already naturally applied and manifested when using a digital tool for joint physical activity planning in cardiac rehabilitation in clinical practice. In a two-week qualitative study, we collected data on expectations, experiences and interactions during the use of a digital health tool by seven persons with CVD and five healthcare professionals. Data was collected by means of observations, interviews, questionnaires and a self-reported diary, and analysed with a particular focus on episodes related to SDM.
We found that SDM was manifested in the situated context to limited extent. For example, we identified high improvement potential for more structured goal-setting and more explicit consideration of preferences and routines. Based on mapping our findings to temporal phases where SDM can be adopted, we highlight implications for design to further support SDM in clinical practice. We consider this as "SDM supportive design in digital health apps," suggesting for example step-by-step guidance to be used during the actual consultation.
This study contributes to further understanding and integration of SDM in digital health tools with a focus on rehabilitation, to empower and support both persons with CVD and healthcare professionals.
医疗保健专业人员与心血管疾病患者之间的共同决策（SDM），可对心血管疾病（CVD）康复在患者日常生活中的长期目标及整合方面的动机、依从性或可持续性产生积极影响。SDM有助于促进从康复机构的常规心脏健康活动向家中更独立活动的过渡，但鉴于时间和资源有限，如在康复的日常实践中，实施SDM往往具有挑战性。数字工具可提供帮助，但必须针对具体使用情况和用户需求进行适当定制。
我们旨在（1）描述在使用我们团队开发的数字工具时，SDM在具体情境中的体现程度，并在此基础上（2）思考如何设计数字健康工具以促进和改善SDM过程。
在一项实地研究中，我们调查了在临床实践中使用数字工具进行心脏康复联合体育活动规划时，SDM是如何自然应用和体现的。在一项为期两周的定性研究中，我们收集了7名CVD患者和5名医疗保健专业人员在使用数字健康工具期间的期望、体验和互动数据。通过观察、访谈、问卷调查和自我报告日记收集数据，并特别关注与SDM相关的事件进行分析。
我们发现SDM在具体情境中的体现程度有限。例如，我们发现更结构化的目标设定以及对偏好和日常习惯的更明确考虑具有很大的改进潜力。基于将我们的研究结果映射到可采用SDM的时间阶段，我们强调了设计方面的启示，以在临床实践中进一步支持SDM。我们将此视为“数字健康应用中的SDM支持性设计”，例如建议在实际咨询期间使用逐步指导。
本研究有助于进一步理解SDM并将其整合到以康复为重点的数字健康工具中，以增强和支持CVD患者及医疗保健专业人员。
