Radboudumc, IQ Health, Nijmegen, Netherlands.
Radboudumc, Oncology, Nijmegen, Netherlands.
Cancer Med. 2024 Oct;13(19):e70218. doi: 10.1002/cam4.70218.
Shared decision-making (SDM) is crucial in pancreatic cancer treatment due to its choice-sensitive nature and limited prognosis. Treatment of pancreatic cancer is organized in a network approach. Several obstacles exist on different levels-patient, healthcare professional, organizational, societal-that impede integration of SDM. This study aims to identify barriers and facilitators to SDM implementation within a comprehensive cancer network.
A qualitative research design was applied, involving interviews and focus groups on barriers and facilitators with healthcare professionals involved in the implementation of SDM. In one comprehensive cancer network in the Netherlands, including seven hospitals, a project was initiated with the goal of empowering patients and healthcare professionals in SDM throughout primary, secondary and tertiary healthcare settings. A total of 17 participants were assessed. Directed qualitative content analysis was performed by two researchers.
Main findings revealed barriers such as time constraints, lack of priority of physicians, little involvement of general practitioners, and insufficient social context of patients in referrals, alongside facilitators including learning communities with practical SDM examples, metro mapping, involvement of case manager in implementation and patient empowerment strategies.
Addressing cultural, systemic barriers and developing innovative strategies are of importance to enhance SDM in pancreatic cancer treatment in a network approach. This study provides understanding of SDM implementation in complex healthcare settings and offers valuable guidance for future interventions seeking to improve decision-making processes in pancreatic cancer treatment and beyond.
由于胰腺癌治疗的选择敏感性和预后有限，共享决策（SDM）在胰腺癌治疗中至关重要。胰腺癌的治疗采用网络方法进行组织。在不同层面——患者、医疗保健专业人员、组织、社会——都存在一些障碍，这些障碍阻碍了 SDM 的整合。本研究旨在确定在综合癌症网络中实施 SDM 的障碍和促进因素。
采用定性研究设计，对参与 SDM 实施的医疗保健专业人员进行了有关障碍和促进因素的访谈和焦点小组。在荷兰的一个综合癌症网络中，包括 7 家医院，启动了一个项目，旨在通过在初级、二级和三级医疗保健环境中为患者和医疗保健专业人员提供权力，来实现 SDM。共评估了 17 名参与者。两名研究人员进行了定向定性内容分析。
主要发现揭示了一些障碍，如时间限制、医生缺乏优先级、全科医生参与度低、以及患者在转诊中社会背景不足，同时还存在一些促进因素，如具有实际 SDM 示例的学习社区、地铁映射、实施过程中案例管理员的参与以及患者赋权策略。
解决文化、系统障碍和开发创新策略对于在网络方法中增强胰腺癌治疗中的 SDM 非常重要。本研究提供了对复杂医疗保健环境中 SDM 实施的理解，并为未来旨在改善胰腺癌治疗和其他领域决策过程的干预措施提供了有价值的指导。
