Barriers and opportunities for shared decision making in clinical practice

T.J. Schuitmaker-Warnaar, Fedde Scheele

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Shared decision-making (SDM) is promoted as tool for improving quality and responsiveness of care, while lowering overall costs. The underlying idea of SDM is well-conceptualised and a wide range of experiments in the Netherlands and abroad have been executed over the last couple of years. However, successful and sustainable implementation remains rather limited. This paper aims to contribute to meaningful implementation by analysing barriers and opportunities for Shared Decision Making and consists of three parts: 1) an overview of key characteristics of SDM, 2) an overview of practical tools for implementation and in what respect these fit key characteristics and goals of SDM, and 3) an analysis of barriers and opportunities.

We conducted a literature review to create an overview of key characteristics and practical tools for implementation. Building on this we interviewed 83 professionals as well as patients, and observed 13 applications of SDM tools and 3 moral case deliberations in four departments of a hospital in Amsterdam: neurology, psychiatry, emergency obstetrics and oncology. We payed extra attention to intercultural differences and competences needed by professionals for applying SDM.

Results show, first, that all existing definitions of SDM focus on a process in which the physician and patient go through multiple phases of decision-making together in which they share preferences and reach an agreement on treatment. SDM holds the middle ground between a paternalistic and an informed decision making model, overcoming informational asymmetry between the physician and patients.

Second, from often used implementation strategies, like option grids, training of professionals, an individual care plan and e-health programs, the individual care plan meets relevant criteria for the SDM process best: information sharing, check of understanding, discussion of pros and cons, mutual agreement and a reflection meeting.

Third, all patients and professionals are supportive of the idea of implementing SDM, but have a broad range on perspectives on what SDM is, possible ways of implementation, and its feasibility. In the obstetrics department, for instance, higher educated patients valued SDM higher and most professionals believed SDM was already implemented.

The results show how meaningful implementation of SDM can be improved by addressing lack of consensus between professionals on 1) what SMD means in practice, 2) appropriate tools for implementation, and 3) whether proposed benefits might be applicable to specific treatment types. Furthermore, the underlying assumption of SDM is that both professional and patient are able to reflect on their position and integrate each other’s knowledge sources. This requires a set of competences (knowledge, attitude and skills) of both parties involved that can be further supported through 1) including competences for dealing with patient feedback in medical training, and 2) aligning with existing moral case deliberation (MCD) practices.
Original languageEnglish
Publication statusPublished - 23 Nov 2017
EventAmsterdam Public Health 2017 -
Duration: 23 Nov 2017 → …


ConferenceAmsterdam Public Health 2017
Period23/11/17 → …


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