Prick J C M, Engelhardt E G, Lansink Rotgerink F K, Deijle I A, van Schaik S M, Garvelink M M, Dahmen R, Brouwers P J A M, van Uden I W M, van der Wees P J, Van den Berg-Vos R M, van Uden-Kraan C F
Santeon, Utrecht, the Netherlands; Department of Neurology, OLVG, Amsterdam, the Netherlands.
Santeon, Utrecht, the Netherlands.
Patient Educ Couns. 2025 Jul;136:108716. doi: 10.1016/j.pec.2025.108716. Epub 2025 Mar 8.
To promote shared decision-making (SDM) during discharge planning of patients with stroke, a patient decision aid (PtDA) was implemented in seven Dutch hospitals. This mixed-methods process evaluation assessed: 1) PtDA use, 2) the SDM process, 3) facilitators and barriers influencing health care professional (HCP) adoption of the PtDA, and 4) HCP experiences with the PtDA.
Rates of PtDA use were derived from hospital registries and PtDA log data. SDM levels in consultations were quantitatively assessed using OPTION-5 (score range 0-100); the SDM process was analyzed qualitatively. Facilitators and barriers were identified via the MIDI questionnaire. HCP experiences were explored through interviews.
PtDA use varied across hospitals, with 10-96 % of patients receiving it and 27-100 % of those ultimately using it. OPTION-5 scores were low in both pre-implementation (n = 68, median:0, Q1-Q3:0-0) and post-implementation consultations (n = 49, median:0, Q1-Q3:0-15). Barriers included lack of whole-team engagement and limited recognition of PtDA benefits. Frequent PtDA use was associated with HCP confidence and self-efficacy in SDM.
Successful PtDA implementation in stroke care requires whole-team engagement, emphasis on PtDA benefits, and enhancing HCP confidence and self-efficacy in SDM.
Highlighting positive SDM outcomes and patient benefits may encourage HCPs to adopt the PtDA.
为促进中风患者出院计划期间的共同决策（SDM），在荷兰的七家医院实施了患者决策辅助工具（PtDA）。这项混合方法的过程评估包括：1）PtDA的使用情况；2）SDM过程；3）影响医护人员（HCP）采用PtDA的促进因素和障碍；4）HCP对PtDA的体验。
PtDA的使用率来自医院登记处和PtDA日志数据。使用OPTION-5（评分范围0-100）对会诊中的SDM水平进行定量评估；对SDM过程进行定性分析。通过MIDI问卷确定促进因素和障碍。通过访谈探索HCP的体验。
PtDA的使用在各医院之间存在差异，10%-96%的患者接受了该工具，其中最终使用该工具的患者比例为27%-100%。实施前（n = 68，中位数：0，四分位距：0-0）和实施后会诊（n = 49，中位数：0，四分位距：0-15）的OPTION-5评分均较低。障碍包括缺乏团队全员参与以及对PtDA益处的认识有限。频繁使用PtDA与HCP在SDM方面的信心和自我效能感相关。
在中风护理中成功实施PtDA需要团队全员参与，强调PtDA的益处，并增强HCP在SDM方面的信心和自我效能感。
突出积极的SDM结果和患者益处可能会鼓励HCP采用PtDA。
