Factors influencing shared decision-making on hospital wards as perceived by healthcare professionals: A qualitative study.

Abstract

Objectives: The extent to which healthcare professionals apply Shared Decision Making (SDM) on hospital wards is still unknown. The aim was to explore the current knowledge of SDM among healthcare professionals and the experienced factors influencing SDM on the wards of Dutch hospitals, regarding both treatment and care decisions.

Setting: Twelve hospital wards in two university medical centres and one teaching hospital.

Design: Explorative qualitative design including semi-structured interviews with healthcare professionals working on hospital wards.

Results: 23 Healthcare professionals of 12 different wards were interviewed about their knowledge and the factors influencing SDM on their hospital ward. Most healthcare professionals had heard about SDM, but their understanding of the concept of SDM differed. Influencing factors were found on three levels. Organizational factors: lack of a clear vision, various approaches of ward rounds, time, and the organizational structure. Patient-related factors: the situation of the patient, participation of relatives and perceptual differences. Healthcare professional-related factors: motivation, experience, workload, continuity of care, familiarity with the patient, interprofessional communication, tools, and education.

Conclusion: All healthcare professionals recognize the importance of SDM and involving the patient in healthcare decisions, because they feel it enhances the quality of care and prioritizes patient-centered care. Nevertheless, healthcare professionals frequently encounter barriers in this setting. To facilitate SDM on hospital wards in the Netherlands, it is beneficial to embed SDM in the inpatient setting and establish a clear structure for interprofessional SDM regarding both treatment and care decisions, in which physicians, nurses and patients play an essential role.