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Implementing shared decision-making in routine practice: barriers and opportunities.

Margaret Holmes-Rovner1, Diane Valade, Catherine Orlowski

  • 1Health Services Research, Michigan State University, East Lansing, MI, USA; Center for Health Care Quality, Blue Cross Blue Shield of Michigan, Detroit, MI, USA; Cardiology Education and Research Department, Oakwood Hospital and Medical Center, Dearborn, MI, USA; Providence Hospital and Medical Centers, Novi, MI, USA; Northern Michigan Hospital: Healthshare Group, Petoskey, MI, USA.

Health Expectations : an International Journal of Public Participation in Health Care and Health Policy
|April 3, 2001
PubMed
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This summary is machine-generated.

Shared decision-making programmes (SDP) face significant implementation challenges in US hospitals due to time pressures. Physician referrals are unreliable, suggesting alternative integration methods are needed for patient access to treatment choice information.

Area of Science:

  • Health Services Research
  • Patient Engagement
  • Clinical Decision Support

Background:

  • Fee-for-service healthcare systems present unique challenges for implementing shared decision-making programmes (SDP).
  • Previous research indicates a need to evaluate the feasibility of these programmes in diverse hospital settings.

Purpose of the Study:

  • To determine the feasibility of implementing shared decision-making programmes (SDP) in US fee-for-service hospital systems.
  • To assess clinician perceptions, identify implementation challenges, and analyze patient referral rates for SDPs.

Main Methods:

  • Survey and participant observation were used to collect data during Phase 1 of a patient outcome study.
  • Evaluations involved 34 nurses and physicians across three Michigan hospitals (rural regional, urban community, urban/suburban teaching).

Related Experiment Videos

  • Two multimedia SDPs focused on surgical treatment choice for breast cancer and ischemic heart disease treatment choice.

    • Main Results:

    • SDP programmes were rated positively for clarity, accuracy, and information appropriateness.
    • Clinicians expressed neutrality regarding patient desire for treatment decision participation.
    • Low patient referral rates (24 in 7 months) were observed, primarily due to time pressures in patient care.

    Conclusions:

    • Productivity and time constraints in US healthcare significantly hinder SDP implementation.
    • Physician referral alone is an unreliable method for ensuring patient access to SDPs.
    • Innovations like integration into informed consent, mandatory use as a quality indicator, or payer reimbursement are proposed.