Development of a structured shared decision-making model for implementation in hospital care

Shared decision-making (SDM) is a core component of patient-centred care, with proven benefits for decision quality and satisfaction. However, its implementation in hospital settings remains limited. This study aimed to describe the development of a SDM model and to evaluate its feasibility, acceptability, and preliminary effects through two pilot implementation studies.

We used a mixed-methods design including the co-creation of an SDM implementation model and two comparative pilot evaluations. Development involved a multidisciplinary team. Pilot implementation was tested with patients with class 3 obesity (n=50) and advanced chronic kidney disease (ACKD; n=38) recruited from outpatient services. The SDM model is a six-step framework comprising clinical decision prioritisation, co-creation of patient decision aids, healthcare professional training, and staged implementation following the three-talk model. Outcomes included feasibility (recruitment and ≥80% process completion), intervention acceptability, and preliminary decision quality indicators (knowledge, satisfaction, decisional conflict) and SDM process measures (SDM-Q-9, CollaboRATE).

Feasibility thresholds were achieved in both pathways, with high adherence. In obesity, SDM participants reported greater knowledge (80.0% vs 48.8%; p<0.001) and higher decision satisfaction (28.0 vs 24.2; p=0.022). In ACKD, SDM participants also showed significantly higher knowledge (91.1% vs 37.1%; p<0.001), while satisfaction and process outcomes were similar between groups.

Our SDM model is a feasible and acceptable framework for the integration of SDM into hospital workflows. Its pilot implementation improved patient knowledge and engagement, supporting its scalability and further evaluation of long-term impact and sustainability.