Fülöp Scheibler, Friedemann Geiger, Kai Wehkamp, Marion Danner, Marie Debrouwere, Constanze Stolz-Klingenberg, Anja Schuldt-Joswig, Christina Gesine Sommer, Olga Kopeleva, Claudia Bünzen, Christine Wagner-Ullrich, Gerhard Koch, Marie Coors, Felix Wehking, Marla Clayman, Christian Weymayr, Leonie Sundmacher, Jens Ulrich Rüffer
{"title":"Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial.","authors":"Fülöp Scheibler, Friedemann Geiger, Kai Wehkamp, Marion Danner, Marie Debrouwere, Constanze Stolz-Klingenberg, Anja Schuldt-Joswig, Christina Gesine Sommer, Olga Kopeleva, Claudia Bünzen, Christine Wagner-Ullrich, Gerhard Koch, Marie Coors, Felix Wehking, Marla Clayman, Christian Weymayr, Leonie Sundmacher, Jens Ulrich Rüffer","doi":"10.1136/bmjebm-2023-112462","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To 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).</p><p><strong>Design: </strong>Pre-post study.</p><p><strong>Setting: </strong>University Hospital Schleswig-Holstein (UKSH), Kiel Campus.</p><p><strong>Participants: </strong>Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH.</p><p><strong>Interventions: </strong>The 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.</p><p><strong>Main outcome measures: </strong>In 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 (PICS<sub>PDM</sub>). Pre-post comparisons were done using t-tests.</p><p><strong>Results: </strong>The 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, PICS<sub>PDM</sub> showed 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.</p><p><strong>Conclusions: </strong>The 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.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":9.0000,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10982630/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Evidence-Based Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjebm-2023-112462","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To 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).
Design: Pre-post study.
Setting: University Hospital Schleswig-Holstein (UKSH), Kiel Campus.
Participants: Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH.
Interventions: The 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 measures: In 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.
Results: The 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, PICSPDM showed 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.
Conclusions: The 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.
目的:评估SHARE To CARE(S2C)计划的可行性和有效性,该计划是一项旨在全医院实施共享决策(SDM)的复杂干预措施。设计:前后研究。设置:石勒苏益格-荷尔斯泰因大学医院(UKSH),基尔校区。参与者:医疗保健专业人员以及来自UKSH基尔校区22个科室的住院患者和门诊患者。干预措施:S2C计划是一项全面的实施战略,包括四个核心模块:(1)医生培训,(3)患者激活和(4)循证患者决策辅助开发和整合到患者路径中。在全面实施后,各部门获得了S2C证书。主要成果衡量标准:在本文中,我们报告了实施的可行性和有效性结果。可行性是根据方案四个单元的执行程度来判断的。有效性的结果测量是患者报告的经验测量(PREM)。有效性的主要结果衡量标准是感知参与护理量表(PICSPDM)的患者决策分量表。使用t检验进行前后比较。结果:在研究的时间框架内,22个纳入部门中的18个部门能够完成S2C计划的四个组成部分的实施。在实施完成后,PICSPDM显示出统计学上的显著差异(P结论:在项目的时间框架内,医院范围内实施SDM和S2C计划被证明是可行和有效的。德国联邦联合委员会建议将SDM的基尔模式作为国家护理标准。
期刊介绍:
BMJ Evidence-Based Medicine (BMJ EBM) publishes original evidence-based research, insights and opinions on what matters for health care. We focus on the tools, methods, and concepts that are basic and central to practising evidence-based medicine and deliver relevant, trustworthy and impactful evidence.
BMJ EBM is a Plan S compliant Transformative Journal and adheres to the highest possible industry standards for editorial policies and publication ethics.