Factors Affecting the Initiation of a Shared Decision Making Program in Obstetric Practices.

Area of Science:

• Implementation Science
• Healthcare Management
• Obstetrics

Background:

• Healthcare systems aim to increase patient engagement through shared decision making (SDM).
• Limited evidence exists for implementing SDM programs, especially in obstetric settings.
• The initiation stage is critical for defining project purpose and establishing support structures.

Purpose of the Study:

• To identify factors influencing the initiation stage of SDM program implementation projects.
• Focus on trial of labor after Cesarean (TOLAC) within obstetric practices.

Main Methods:

• Multiple-case study design in three obstetric settings in Washington State.
• Utilized implementation science frameworks and project management literature.
• Data collected through interviews with key informants and review of implementation documents.

Main Results:

• External demands, such as state decision aid certification programs, influenced project purpose and stakeholder engagement.
• These external pressures may not align with internal requirements for long-term SDM program sustainability.
• Identified project implementation factors are crucial for planning, execution, and evaluation.

Conclusions:

• The initiation stage is significantly shaped by external requirements, potentially impacting SDM program viability.
• Findings offer insights for strategizing early-stage SDM implementation projects in obstetrics.
• Understanding these dynamics is key for successful and sustainable SDM program integration.