Barriers and facilitators to implement shared decision making in multidisciplinary sciatica care: a qualitative study

Abstract

BackgroundThe Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.MethodsWe conducted 40 semi-structured interviews with professionals involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons) and three focus groups among patients (six to eight per group). The interviews and focus groups were audiotaped and transcribed in full. Reported barriers and facilitators were classified according to the framework of Grol and Wensing. The software package Atlas.ti 7.0 was used for analysis.ResultsProfessionals reported 53 barriers and 5 facilitators, and patients 35 barriers and 18 facilitators for SDM in sciatica care. Professionals perceived most barriers at the level of the organizational context, and facilitators at the level of the individual professional. Patients reported most barriers and facilitators at the level of the individual professional. Several barriers and facilitators correspond with barriers and facilitators found in the literature (e.g., lack of time, motivation) but also new barriers and facilitators were identified. Many of these new barriers mentioned by both professionals and patients were related to the multidisciplinary setting, such as lack of visibility, lack of trust in expertise of other disciplines, and lack of communication between disciplines.ConclusionsThis study identified barriers and facilitators for SDM in the multidisciplinary sciatica setting, by both professionals and patients. It is clear that more barriers than facilitators are perceived for implementation of SDM in sciatica care. Newly identified barriers and facilitators are related to the multidisciplinary care setting. Therefore, an effective implementation strategy of SDM in a multidisciplinary setting such as in sciatica care should focus on these barriers and facilitators.

Experienced barriers in shared decision‐making behaviour of orthopaedic surgery residents compared with orthopaedic surgeons

“…External factors outside of the physician's perceived control contributed to the low score in perceived behavioural control. This resonates with other research findings, in which physicians experienced many barriers owing to external factors when implementing SDM (Gravel et al, ; Hofstede et al, ). In a review study by Gravel et al (), the most important obstacles to implementing SDM mentioned by physicians were time constraints, characteristics of the patient and clinical context.…”

Patients' and clinicians' perspectives on shared decision‐making regarding treatment decisions for depression, anxiety disorders, and obsessive‐compulsive disorder in specialized psychiatric care

“…Each new transcript was systematically compared with prior ones, to ensure that characteristics of and differences between the data were identified and incorporated into the analysis. We used concept maps, with our research questions as a framework, to group the data and to look for similarities and differences across the data . The most important themes regarding SDM (mentioned in all focus groups) and their relationships are displayed in concept maps shown in Figure A,B (patient and professional perspectives, respectively).…”

The Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards: A development and psychometric validation study

“…Healthcare worker-related factors and information sharing and dialogue: initial tool (88 items) The six components identified from the models of Longtin et al (2010) and Tambuyzer et al (2011) were further developed with research from the literature review. Hofstede et al (2013) found that lack of knowledge about shared decision making, poor professional behavior and negative interpersonal relationships were perceived by patients and healthcare workers as barriers on micro-level for patient participation. These three elements (i.e.…”