Comprehensive Implementation of Shared Decision Making in a Neuromedical Center Using the SHARE TO CARE Program

Constanze Stolz-Klingenberg; Claudia Bünzen; Marie Coors; Charlotte Flüh; Klarissa Hanja Stürner; Kai Wehkamp; Marla L Clayman; Fueloep Scheibler; Jens Ulrich Rüffer; Wiebke Schüttig; Leonie Sundmacher; Daniela Berg; Friedemann Geiger

doi:10.2147/PPA.S388432

Comprehensive Implementation of Shared Decision Making in a Neuromedical Center Using the SHARE TO CARE Program

Patient Prefer Adherence. 2023 Jan 13:17:131-139. doi: 10.2147/PPA.S388432. eCollection 2023.

Authors

Constanze Stolz-Klingenberg¹, Claudia Bünzen¹, Marie Coors², Charlotte Flüh³, Klarissa Hanja Stürner⁴, Kai Wehkamp^{5

6}, Marla L Clayman^{7

8}, Fueloep Scheibler^{1

9}, Jens Ulrich Rüffer^{9

10}, Wiebke Schüttig², Leonie Sundmacher², Daniela Berg⁴, Friedemann Geiger^{1

9

11}

Affiliations

¹ National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany.
² Chair of Health Economics, Technical University of Munich, Munich, Germany.
³ Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany.
⁴ Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
⁵ Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany.
⁶ Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany.
⁷ Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, MA, USA.
⁸ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁹ SHARE TO CARE Patientenzentrierte Versorgung GmbH, Cologne, Germany.
¹⁰ TakePart Media+Science GmbH, Cologne, Germany.
¹¹ Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.

Abstract

Purpose: SHARE TO CARE (S2C) is a comprehensive, multi-module implementation program for shared decision making (SDM). It is currently applied at the University Hospital Schleswig-Holstein in Kiel, Germany, and among general practitioners at the Federal State of Bremen. This study examines the results of the full implementation of S2C in terms of effectiveness within the Kiel Neuromedical Center comprising the departments of neurology and neurosurgery.

Method and design: The S2C program consists of four combined intervention modules: 1) multimodal training of physicians; 2) a patient activation campaign including the ASK-3 method; 3) digital evidence-based patient decision aids; and 4) SDM support by nurses, e.g., as decision coaches. The SDM level before and immediately after implementation was retrospectively assessed in consecutively selected patients on the subscale "Patient Decision Making" of the Perceived Involvement in Care Scale (PICS_PDM). Mean scores were compared with t-tests.

Results: Eighty-nine percent of all physicians (N = 56) completed the SDM training. We developed a total of 12 evidence-based digital decision aids in the center, educated two decision coaches to support patients' decision processes by using decision aids. Physicians adjusted patients' pathways to incorporate the use of decision aids. Patients (n = 261) reported a significant increase in participation (p<0.001; Hedges' g = 0.49) in medical decision making.

Conclusion: The S2C program has been successfully implemented within the entire Neuromedical Center. Patients reported a medium to small increase of perceived involvement in decision making demonstrating the effectiveness of the implementation. For future research, it might be interesting to investigate the sustainability of the effects of S2C. In addition, it seems useful to complement the patient-based evaluation with observer-based data.

Keywords: SDM; decision aids; neurology; neurosurgery; patient activation; physician training; shared decision making intervention.

Grants and funding

The SHARE TO CARE project was funded by the German Innovation Fund of the Federal Joint Committee (NVF17009) and the Medical Faculty of the Kiel University.