Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre–post trial

Abstract

ObjectivesTo 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).DesignPre–post study.SettingUniversity Hospital Schleswig-Holstein (UKSH), Kiel Campus.ParticipantsHealthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH.InterventionsThe 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 measuresIn 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.ResultsThe 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, PICSPDMshowed 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.ConclusionsThe 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.

Partizipative Entscheidungsfindung in der Notfallmedizin

“…Das bislang umfassendste Programm SHARE TO CARE fand am Kieler Campus des Universitätsklinikums Schleswig-Holstein statt, gefördert vom Gemeinsamen Bundesausschuss im Zeitraum 01.10.2017 bis 30.09.2021 [8]. Aspekte der Entscheidungsfindung und PatientInnenzufriedenheit konnten darin nachweislich verbessert werden [24]. Folg-lich hat der Gemeinsame Bundesausschuss in seiner Stellungnahme zum Projekt eine Empfehlung zur Routineimplementierung der partizipativen Entscheidungsfindung in das deutsche Gesundheitssystem ausgesprochen und an das Bundesgesundheitsministerium übermittelt.…”

Effects of a shared decision‐making implementation programme on patient‐centred communication in oncology—Secondary analysis of a randomised controlled trial

“…However, PCC and SDM are still not fully implemented in routine cancer care, and studies on the effectiveness and implementation of PC communication and SDM are necessary to fill this gap 5,18 . In Germany, two larger‐scale studies investigating the implementation of SDM in routine cancer care by multiple strategies have recently been conducted (SHARE TO CARE and PREPARED) 21,22 . While the SHARE TO CARE study reported encouraging findings, 22 outcome evaluations of the PREPARED trial revealed no statistically significant intervention effects on the primary outcome of SDM as experienced by patients and on most secondary outcomes, including observer‐rated SDM in clinical encounters 21 .…”

“…In Germany, two larger‐scale studies investigating the implementation of SDM in routine cancer care by multiple strategies have recently been conducted (SHARE TO CARE and PREPARED) 21,22 . While the SHARE TO CARE study reported encouraging findings, 22 outcome evaluations of the PREPARED trial revealed no statistically significant intervention effects on the primary outcome of SDM as experienced by patients and on most secondary outcomes, including observer‐rated SDM in clinical encounters 21 . However, within the PREPARED trial, it was not assessed whether the implementation programme might have had an impact on the general PC communication skills of physicians.…”