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Insights into successful implementation of a shared decision-making (SDM)-intervention for patients with renal cell
Cato C Bresser1, Harm H E van Melick2, Birgitta M M van den Berg3
1St. Antonius Hospital, Dept. of Urology, Nieuwegein, Utrecht, the Netherlands; St. Antonius Hospital, Dept. of Value Improvement, Nieuwegein, Utrecht, the Netherlands; Radboudumc, IQ Health, Nijmegen, the Netherlands.
Objectives:
Shared decision-making (SDM) and patient decision aids (PtDAs) can improve the quality of treatment decisions, yet their uptake in routine care often remains limited. To determine whether a SDM intervention for renal cell carcinoma (RCC) can be sustainably integrated into clinical practice, this study aimed to 1) assess implementation of a SDM intervention, 2) evaluate PtDA use by patients, and 3) explore the experiences of patients and healthcare professionals (HCPs) with the implementation process and the PtDA.
Methods:
Preplanned mixed methods evaluation of the implementation of a SDM intervention, consisting of a PtDA and HCP training, in six Dutch hospitals. Implementation activities were documented, PtDA use rates were derived from log data. To assess experiences from end-users, semi-structured interviews were conducted with patients and HCPs.
Results:
The SDM intervention was implemented across all six participating hospitals, with only minor adaptations to local workflows. Although the overall implementation structure was similar, there was variation in the timing of PtDA provision, the HCPs involved and patient participation rates. The majority of patients accessed and used the PtDA, completed values-clarification exercises and reported high levels of satisfaction. Both patients and HCPs viewed the PtDA as a valuable, structured tool that facilitated SDM and enhanced the quality and focus of treatment consultations in routine RCC care.
Conclusions:
These findings suggest that a structured implementation strategy could successfully integrate a SDM intervention into RCC care.
Practice Implications:
To ensure long-term, widespread adoption of the SDM intervention in routine practice, sustained integration requires attention to key process factors, such and sufficient resources and collective team engagement.