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Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making

Amy Lloyd1, Natalie Joseph-Williams, Adrian Edwards

  • 1Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, Cardiff, CF, 14 4YS, UK. glynelwyn@gmail.com.

Implementation Science : IS
|September 7, 2013
PubMed
Summary
This summary is machine-generated.

Implementing shared decision making in healthcare requires more than just patient tools. Successful integration hinges on healthcare teams sharing a common purpose and understanding, which is often a barrier.

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Area of Science:

  • Healthcare implementation science
  • Patient engagement strategies
  • Clinical practice improvement

Background:

  • Implementing shared decision making (SDM) into routine practice is complex and challenging.
  • Few studies report successful SDM implementation beyond research settings.
  • The MAking Good Decisions In Collaboration (MAGIC) program aimed to identify best practices for SDM implementation.

Purpose of the Study:

  • To investigate healthcare professionals' perspectives on implementing shared decision making.
  • To examine the specific work required for successful SDM integration.
  • To inform future efforts in SDM implementation.

Main Methods:

  • The MAGIC program utilized workshops, decision support tools (Option Grids), and patient activation campaigns.
  • Semi-structured interviews were conducted with 31 healthcare professionals across three secondary care teams.
  • Interview data were coded using the Normalization Process Theory framework.

Main Results:

  • Partial implementation of SDM was explained by Normalization Process Theory components: coherence, cognitive participation, collective action, and reflexive monitoring.
  • SDM integration occurred when teams shared coherent views, engaged in intervention development, and interventions aligned with existing practices.
  • Conflicting attitudes and a lack of shared understanding ('coherence') were significant barriers.

Conclusions:

  • SDM implementation is more complex than providing patient decision support tools.
  • Normalizing SDM requires intensive work to establish shared understanding and facilitate attitudinal shifts among professionals.
  • Divergent views on patient engagement remain a key obstacle to SDM implementation.