Implementing a shared decision-making and cognitive strategy-based intervention: Knowledge user perspectives and recommendations

Kay-Ann M Allen; Katherine R Dittmann; Jennifer A Hutter; Catherine Chuang; Michelle L Donald; Amie L Enns; Nina Hovanec; Anne W Hunt; Richard S Kellowan; Elizabeth A Linkewich; Alexandra S Patel; Anisha Rehmtulla; Sara E McEwen

doi:10.1111/jep.13329

Implementing a shared decision-making and cognitive strategy-based intervention: Knowledge user perspectives and recommendations

J Eval Clin Pract. 2020 Apr;26(2):575-581. doi: 10.1111/jep.13329. Epub 2019 Dec 12.

Authors

Kay-Ann M Allen¹, Katherine R Dittmann¹, Jennifer A Hutter^{1

2

3}, Catherine Chuang⁴, Michelle L Donald⁵, Amie L Enns⁶, Nina Hovanec⁷, Anne W Hunt^{8

3}, Richard S Kellowan^{9

10

3}, Elizabeth A Linkewich^{4

3}, Alexandra S Patel^{8

3}, Anisha Rehmtulla⁴, Sara E McEwen^{1

11}

Affiliations

¹ St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
² Department of Kinesiology, McMaster University, Toronto, ON, Canada.
³ Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
⁴ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁵ Health System Planning & Engagement, Central Local Health Integration Network, Toronto, ON, Canada.
⁶ Neurological Rehabilitation Services, West Park Healthcare Centre, Toronto, ON, Canada.
⁷ Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
⁸ Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada.
⁹ Bridgepoint Active Healthcare, Sinai Health System, Toronto, ON, Canada.
¹⁰ Stroke & Neuro Rehab, Providence Healthcare, Toronto, ON, Canada.
¹¹ Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.

PMID: 31828869
DOI: 10.1111/jep.13329

Abstract

The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision-making (SDM)-based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy-based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO-OP) to treat survivors of stroke. At the end of the 4-month CO-OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO-OP site champions. A semi-structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio-recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO-OP implementation were extracted and co-constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context-specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem-solving within the relevant practice context.

Keywords: cognition; focus groups; iPARIHS; problem solving; qualitative research; shared decision making; stroke; translational medical research.

MeSH terms

Cognition
Decision Making, Shared
Humans
Physical Therapists*
Qualitative Research
Stroke Rehabilitation*
Stroke*

Abstract

MeSH terms

Grants and funding