Shared Decision-Making in the Management of Deep Partial-Thickness Burns: Development and Implementation of a...

In burn care, one of the most debated topics is the optimal treatment of patients with deep partial-thickness burns. With these patients, the decision must be made to perform early surgery or to wait and potentially limit, or even avoid, surgery. Both options are available in Dutch burn care, and the best treatment option is decided on clinical outcomes as well as patients' preferences. This complexity highlights the need for shared decision-making (SDM) and a decision aid (DA) to facilitate this process.

This study aimed to support patients and health care professionals (HPs) in the process of SDM regarding the treatment decision for deep partial-thickness burns by developing and implementing a DA.

This multimethod design was conducted in a Dutch burn care setting between September 2023 and October 2025 and included 3 phases. Phase 1 (needs assessment) included semistructured interviews with patients, analyzed using a qualitative descriptive approach with deductive and inductive coding, and an online survey of HPs with a descriptive analysis of closed-ended questions and inductive content analysis of open-ended questions by 2 researchers. Phase 2 (development) involved 5 co-design sessions with patients, HPs, and researchers. The think-aloud method was used for usability testing with patients and HPs. Additionally, HPs participated in acceptability testing using interviews guided by the Consolidated Framework for Implementation Research, and analyzed using deductive thematic analysis. Phase 3 (implementation) consisted of a 6-month pilot period, including patient interviews, 3 focus groups with HPs, usage data, and the Normalization Measure Development questionnaire to assess the level of normalization.

Eight patient interviews revealed 2 distinct information needs: patients seeking detailed treatment information and those preferring to defer decisions to clinicians. The HPs survey (response rate 36%) showed that burn physicians typically make the final treatment decisions, although SDM was considered preferable, and 91.2% (31/34) supported the use of a DA. Usability testing with 4 patients and 7 HPs showed overall satisfaction, with minor revisions suggested, such as clarifying text and illustrations. Key implementation facilitators included professional engagement and local support, while infrastructure was the main barrier. The final DA comprised a paper handout sheet, an interactive website, and a summary sheet capturing patient preferences. During the pilot, the DA was distributed 42 times and used by 28 patients (67% participation rate). Both patients and HPs reported positive experiences, and the tool was considered feasible to integrate into routine care.

A DA for the treatment of deep partial-thickness burns was successfully developed and implemented using a comprehensive, user-centered approach. It supports SDM and patient-centered care by providing tailored information and helping patients participate more actively in treatment decisions.