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Scheibler F, Geiger F, Wehkamp K, Danner M, Debrouwere M, Stolz-Klingenberg C, Schuldt-Joswig A, Sommer CG, Kopeleva O, Bünzen C, Wagner-Ullrich C, Koch G, Coors M, Wehking F, Clayman M, Weymayr C, Sundmacher L, Rüffer JU. Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial. BMJ Evid Based Med 2024; 29:87-95. [PMID: 37890982 PMCID: PMC10982630 DOI: 10.1136/bmjebm-2023-112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM). DESIGN Pre-post study. SETTING University Hospital Schleswig-Holstein (UKSH), Kiel Campus. PARTICIPANTS Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH. INTERVENTIONS The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate. MAIN OUTCOME MEASURES In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre-post comparisons were done using t-tests. RESULTS The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDM showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects. CONCLUSIONS The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
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Affiliation(s)
- Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
| | - Friedemann Geiger
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marion Danner
- DARUM Marion Danner und Anne Rummer GbR, Cologne, Germany
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Constanze Stolz-Klingenberg
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Anja Schuldt-Joswig
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christina Gesine Sommer
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Olga Kopeleva
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
- Department of General Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Claudia Bünzen
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christine Wagner-Ullrich
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Gerhard Koch
- Department for Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
| | - Marie Coors
- Department of Health Economics, Technical University of Munich, München, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Marla Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christian Weymayr
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, München, Germany
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Langbroek GB, Ronde EM, Lapid O, Horbach SER, van der Horst CMAM, Breugem CC, Ubbink DT. Healthcare professionals' views on shared decision-making in plastic surgery in the Netherlands. J Plast Reconstr Aesthet Surg 2023; 85:463-472. [PMID: 37597483 DOI: 10.1016/j.bjps.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. METHODS Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. RESULTS We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. CONCLUSIONS Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.
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Affiliation(s)
- Ginger Beau Langbroek
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Elsa M Ronde
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Oren Lapid
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Sophie E R Horbach
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Miller T, Reihlen M. Assessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 110:107652. [PMID: 36804578 DOI: 10.1016/j.pec.2023.107652] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patient involvement has become an important and lively field of research, yet existing findings are fragmented and often contested. Without a synthesis of the research field, these findings are of limited use to scholars, healthcare providers, or policy-makers. OBJECTIVE Examine the body of knowledge on patient involvement to determine what is known, contested, and unknown about benefits, risks, and effective implementation strategies. PATIENT INVOLVEMENT Patients were not involved. METHODS Systematic literature review of 99 journal articles using a conceptual model integrating three levels: health systems, health providers, and patients. We extracted individual research findings and organized them into the structure of our model to provide a holistic picture of patient involvement. RESULTS The review highlights overlaps and conflicts between various patient involvement approaches. Our results show benefits for individual patients and the health system as a whole. At the provider level, however, we identified clear barriers to patient involvement. DISCUSSION Patient involvement requires collaboration among health systems, healthcare providers, and patients. We showed that increasing patient responsibility and health literacy requires policy-maker interventions. This includes incentives for patient education by providers, adapting medical education curricula, and building a database of reliable health information and decision support for patients. Furthermore, policies supporting a common infrastructure for digital health data and managed patient data exchange will foster provider collaboration. PRACTICAL VALUE Our review shows how an approach integrating health systems, healthcare providers, and patients can make patient involvement more effective than isolated interventions. Such systematic patient involvement is likely to improve population health literacy and healthcare quality.
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Affiliation(s)
- Thomas Miller
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
| | - Markus Reihlen
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
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Biel M, Grondys K, Androniceanu AM. A Crisis in the Health System and Quality of Healthcare in Economically Developed Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:469. [PMID: 36612791 PMCID: PMC9819705 DOI: 10.3390/ijerph20010469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
A health crisis caused by a pandemic tested the effectiveness of national healthcare systems by testing both financing and organizational and technical performance of patient care. At that time, the structural flaws in healthcare systems and inequalities in the level of healthcare in its different dimensions and countries due to resource constraints were highlighted. Therefore, the paper concentrates on investigating how the crisis in the health system affects the quality of healthcare services as a result of changes in the availability of financial, material, and human resources belonging to this system. The quantitative data, in terms of healthcare characterizing the OECD countries and selected non-member economies, treated as an example of economically developed regions, were chosen for the analysis. The study included five areas of resources, i.e., demographic, financial, human, technical, and the delivery of basic services in healthcare. T-test method for dependent samples, supplemented with Hedge's g statistics, was applied to test the differences between the mean values of individual indicators. The results indicate the occurrence of changes in some areas of the healthcare system due to a crisis. Identifying areas that are particularly vulnerable to sudden changes in the healthcare system helps to understand which resource areas need to be strategically managed first, as shifts in levels respond to deteriorating healthcare quality outcomes.
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Affiliation(s)
- Magdalena Biel
- Faculty Management, Czestochowa University of Technology, Armii Krajowej 19b, 42-200 Czestochowa, Poland
| | - Katarzyna Grondys
- Faculty Management, Czestochowa University of Technology, Armii Krajowej 19b, 42-200 Czestochowa, Poland
| | - Ane-Mari Androniceanu
- Doctoral School of Management, The Bucharest University of Economic Studies, Piața Romană 6, 010374 Bucharest, Romania
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