Most important factors for the implementation of shared decision making in sciatica care: ranking among professionals and patients

Stefanie N Hofstede; Leti van Bodegom-Vos; Manon M Wentink; Carmen L A Vleggeert-Lankamp; Thea P M Vliet Vlieland; Perla J Marang-van de Mheen; DISC study group

doi:10.1371/journal.pone.0094176

Most important factors for the implementation of shared decision making in sciatica care: ranking among professionals and patients

PLoS One. 2014 Apr 7;9(4):e94176. doi: 10.1371/journal.pone.0094176. eCollection 2014.

Authors

Stefanie N Hofstede¹, Leti van Bodegom-Vos¹, Manon M Wentink¹, Carmen L A Vleggeert-Lankamp², Thea P M Vliet Vlieland³, Perla J Marang-van de Mheen¹; DISC study group

Collaborators

DISC study group:
W J J Assendelft, L van Bodegom-Vos, W B van den Hout, P J Marang-van de Mheen, A M Stiggelbout, C L A Vleggeert-Lankamp, T P M Vliet Vlieland, L Voogt, P C A J Vroomen

Affiliations

¹ Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
² Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Introduction: Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy.

Methods: 246 professionals (general practitioners, physical therapists, neurologists, neurosurgeons, orthopedic surgeons) (30% response) and 155 patients (96% response) responded to an internet-based survey. Respondents ranked barriers and facilitators identified in previous interviews, on their importance using Maximum Difference Scaling. Feeding back the personal top 5 most important factors, each respondent indicated whether these factors were barriers or facilitators. Hierarchical Bayes estimation was used to estimate the relative importance (RI) of each factor.

Results: Professionals assigned the highest importance to: quality of professional-patient relationship (RI 4.87; CI 4.75-4.99); importance of quick recovery of patient (RI 4.83; CI 4.69-4.97); and knowledge about treatment options (RI 6.64; CI 4.53-4.74), which were reported as barrier and facilitator. Professionals working in primary care had a different ranking than those working in hospital care. Patients assigned the highest importance to: correct diagnosis by professionals (barrier, RI 8.19; CI 7.99-8.38); information provision about treatment options and potential harm and benefits (RI 7.87; CI 7.65-8.08); and explanation of the professional about the care trajectory (RI 7.16; CI 6.94-7.38), which were reported as barrier and facilitator.

Conclusions: Knowledge, information provision and a good relationship are the most important conditions for SDM perceived by both patients and professionals. These conditions are not restricted to one specific disease or health care system, because they are mostly professional or patient dependent and require healthcare professional training.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Decision Making*
Humans
Patient Care / psychology*
Patients / psychology*
Physicians / psychology*
Sciatica / therapy*

Grants and funding

This research project is supported by a grant from the Netherlands Organization for Health Research and Development (grant number 171203003). Funding was obtained from the Netherlands Organization for Scientific Research (NWO) Incentive Fund Open Access Publications. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.