IntroductionSHARE TO CARE (S2C) is a comprehensive implementation program for shared decision making (SDM). It is run at the University Hospital Schleswig-Holstein (UKSH) in Kiel, Germany, and consists of four combined intervention modules addressing healthcare professionals and patients: (1) multimodal training of physicians (2) patient activation campaign including the ASK3 method, (3) online evidence-based patient decision aids (4) SDM support by nurses. This study examines the sustainability of the hospital wide SDM implementation by means of the Neuromedical Center comprising the Departments of Neurology and Neurosurgery.MethodsBetween 2018 and 2020, the S2C program was applied initially within the Neuromedical Center: We implemented the patient activation campaign, trained 89% of physicians (N = 56), developed 12 patient decision aids and educated two decision coaches. Physicians adjusted the patients' pathways to facilitate the use of decision aids. To maintain the initial implementation, the departments took care that new staff members received training and decision aids were updated. The patient activation campaign was continued. To determine the sustainability of the initial intervention, the SDM level after a maintenance phase of 6–18 months was compared to the baseline level before implementation. Therefore, in- and outpatients received a questionnaire via mail after discharge. The primary endpoint was the “Patient Decision Making” subscale of the Perceived Involvement in Care Scale (PICSPDM). Secondary endpoints were an additional scale measuring SDM (CollaboRATE), and the PrepDM scale, which determines patients' perceived health literacy while preparing for decision making. Mean scale scores were compared using t-tests.ResultsPatients reported a significantly increased SDM level (PICSPDMp = 0.02; Hedges' g = 0.33; CollaboRATE p = 0.05; Hedges' g = 0.26) and improved preparation for decision making (PrepDM p = 0.001; Hedges' g = 0.34) 6–18 months after initial implementation of S2C.DiscussionThe S2C program demonstrated its sustainability within the Neuromedical Center at UKSH Kiel in terms of increased SDM and health literacy. Maintaining the SDM implementation required a fraction of the initial intensity. The departments took on the responsibility for maintenance. Meanwhile, an additional health insurance-based reimbursement for S2C secures the continued application of the program.ConclusionSHARE TO CARE promises to be suitable for long-lasting implementation of SDM in hospitals.

Background Numerous articles and reviews discussed the effects of shared decision making (SDM) on concept-specific and direct outcomes, showing great variety in methodology and results. Objectives This scoping review accentuates effects of shared decision making interventions on more distal and distant outcomes related to the healthcare experience of patients and physicians, the economy and treatment parameters. Eligibility criteria The search considered randomized controlled trials (RCTs), their secondary analyses and follow-up reports comparing shared decision making interventions against control conditions. Sources of evidence MEDLINE (through PubMed) and reference lists of included articles were systematically appraised. Charting methods First, relevant outcome effects were extracted following the authors’ conclusions. Second, all outcomes were sorted into one of five different effect levels: individual, interactional, organizational, systemic and clinical. Results The search process identified 120 eligible reports, representing 116 randomized controlled trials and four follow-up reports with a variety in research topics, intervention types, outcome measurements and effects. Most of the 298 extracted outcomes were reported as not affected by shared decision making (204). While some outcomes improved at least slightly (83), few tended to decline (9) or revealed mixed results (2). Considering the five outcome effect levels, individual and clinical outcomes were reported more frequently than interactional, organizational and systemic ones. However, many individual outcomes could be counted as systemic and vice versa. Conclusions Shared decision making can improve distal and distant outcomes depending on the healthcare context. Individual, systemic and clinical outcomes have been more frequently appraised than interactional and organizational ones. Single database search and limited assessment of articles’ risk of bias and effect size narrow reliability of our results.

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