Improving shared decision-making in pharmacist-led haematology clinics: a 'Plan Do Study Act' approach

Abstract

Introduction: The concept of person-centred care is regarded as an essential approach to healthcare. A core component of person-centred care is the shared decision-making process. There is evidence that effective shared decision-making can improve people's satisfaction with their care. This quality improvement project used the 'Plan Do Study Act' (PDSA) cycles to test the small changes made and to assess their impact on shared decision-making in clinic consultations.

Objective: To enhance patient satisfaction in pharmacist-led haematology clinics by improving shared decision-making.

Methods: Patients from a haematology clinic participated in a survey based on the validated 'Benefit, Risk, Alternatives, do Nothing' (BRAN) questions, which encourage patients' involvement in shared decision-making conversations with clinicians. Data were collected from 142 consultations over 3 months, using three PDSA cycles, which provided the structure to implement changes, evaluate their impact, and build on the learning from previous cycles. The first cycle analysed the shared decision-making in the clinic. The second cycle involved shared decision-making training for pharmacists. On the third cycle, decision-making aid leaflets were implemented.

Results: First cycle results showed patients were mostly satisfied with the 'Benefit' statement. The second cycle revealed satisfaction improvements on 'Risk'. On the third cycle, satisfaction increased on the 'do Nothing' statement. The baseline mean of the patient satisfaction score increased from 3.25/5 at the start to 3.75/5 by the end of the study.

Conclusions: The results show that each cycle had a positive effect, suggesting that training specialist pharmacists in person-centred care and shared decision-making led to an improvement in patient satisfaction. Encouraging patients to be involved in shared decision-making enabled them to ask questions in consultations and led to improved satisfaction. The project highlighted the importance of developing the skills and knowledge of the pharmacy workforce to support the needs of an expanding and ageing cancer population.

Keywords: hematology; hospital; pharmacy service; professional competence; quality of health care; workforce.