Integrating Shared Decision Making and Decision Support Tools into Clinical Practice Guidelines: What Does It Take? A Qualitative Study.

Abstract

Background. Awareness of shared decision making (SDM) is growing, but its integration into clinical practice guidelines (CPGs) remains challenging. We sought expert insights to identify strategies for more successfully integrating SDM and decision support tools into CPGs. Specifically, our objectives were to determine 1) how to identify CPG recommendations where SDM is most relevant and 2) what factors in CPG development hinder or facilitate the consideration of SDM and the development of decision support tools. Methods. We conducted semi-structured interviews with experts on CPGs and SDM. We analyzed the data using Mayring's qualitative content analysis. Results. The 16 interviewed participants proposed several determinants of and strategies for identifying SDM-relevant recommendations. The most frequently mentioned determinant was "multiple options with benefits and harms where choices depend on individual preferences." The most frequently mentioned strategy was prioritization, similar to the CPG scoping phase. Participants highlighted the role of patient partners in facilitating the consideration of SDM in CPG development but noted that a supportive culture toward both patient and public involvement and SDM is needed. The absence of standardized methods and inadequate resources hinder the consideration of SDM and the combined development of CPGs and decision support tools. The current format of CPGs was deemed overwhelming, while the inclusion of choice awareness in CPG recommendations could facilitate SDM. Conclusions. The identified strategies provide a starting point for CPG organizations to explore ways for integrating SDM and decision support tools into CPGs while considering context-specific barriers and facilitators. Implications. Further research is needed to assess the usefulness and feasibility of the proposed strategies. New policies and stronger collaboration between CPG and SDM communities appear to be needed to address identified barriers.HighlightsWe explored expert knowledge and experience on how to successfully integrate shared decision making (SDM) and decision support tools into clinical practice guidelines (CPGs).A combined development of CPGs and decision support tools was deemed essential; however, development processes often remain separate, with the CPG development group unaware of the decision support tool development group, and vice versa.In addition to stating choice awareness in CPGs, participants highlighted the critical role of patient partners in considering SDM in CPG development, but resource issues and a culture that neglects patient involvement and SDM remain.For CPG development groups to consider SDM and for health care professionals to practice it, things need to be as easy as possible.