Artikel
Development and testing of a tool to foster shared decision-making between patients and healthcare professionals in clinical practice guidelines
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Autoren
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Lena Fischer
- Brandenburg Medical School Theodor Fontane, Institute For Health Services And Health System Research, Rüdersdorf, Deutschland; Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Rüdersdorf, Deutschland
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Fülöp Scheibler
- University Hospital Schleswig-Holstein, National Competency Center for Shared Decision Making, Kiel, Deutschland; SHARE TO CARE. Patient-centered care GmbH, Cologne, Deutschland
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Corinna Schaefer
- German Agency for Quality in Medicine, Berlin, Deutschland
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Torsten Karge
- CGS Clinical Guideline Services GmbH, Berlin, Deutschland
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Thomas Langer
- German Network for Evidence-based Medicine, Berlin, Deutschland
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Leon Vincent Schewe
- SHARE TO CARE. Patient-centered care GmbH, Cologne, Deutschland
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Ivan D. Florez
- Clínica Las Américas-AUNA, Pediatric Intensive Care Unit, Medellin, Kolumbien; McMaster University, School of Rehabilitation Science, Hamilton, Kanada; University of Antioquia, Department of Pediatrics, Medellin, Kolumbien
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Sheyu Li
- Sichuan University, Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Chengdu, China, VR
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Marta Maes-Carballo
- Hospital Público Verín, General Surgery Department, Ourense, Spanien; University of Santiago de Compostela, Department of General Surgery, Santiago de Compostela, Spanien; Healthcare Ethics Committee of Ourense, Ourense, Spanien
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Zachary Munn
- University of Adelaide, Adelaide, Australien
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Lilisbeth Perestelo-Perez
- Canary Islands Health Service, Evaluation Unit (SESCS), Tenerife, Spanien; Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spanien; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spanien
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Livia Puljak
- Catholic University of Croatia, Center for Evidence-Based Medicine and Healthcare, Zagreb, Kroatien
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Anne Stiggelbout
- Leiden University Medical Center, Medical Decision Making, Department of Biomedical Data Sciences, Leiden, Niederlande; Erasmus University Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, Niederlande
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Dawid Pieper
- Brandenburg Medical School Theodor Fontane, Institute For Health Services And Health System Research, Rüdersdorf, Deutschland; Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Rüdersdorf, Deutschland
| Veröffentlicht: | 10. September 2024 |
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Gliederung
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Background: Shared decision-making (SDM) is advocated to consider patients’ values and preferences in medical decision-making, particularly for preference-sensitive recommendations in clinical practice guidelines (henceforth guidelines). This includes guideline recommendations where there are multiple treatment options that are relatively balanced in terms of benefits, harms, and treatment burdens, or where trade-offs between options call for the inclusion of individual preferences. Patient decision aids (PDAs) play a central role in supporting the SDM process and can be a vehicle for linking guidelines and SDM, where they do not match with each other effectively. Integrating PDAs into SDM-relevant guideline recommendations may be a strategy to overcome these shortcomings and enable SDM through guidelines. However, there are currently no established methods for systematically identifying and prioritizing guideline recommendations based on their relevance for SDM.
Objective: To develop a tool that enables guideline developers to systematically identify and prioritize guideline recommendations for which SDM is particularly relevant.
Methods: The project consists of six steps.
- 1.
- We conduct a scoping review in bibliographic databases and grey literature sources to identify methods used to foster SDM through PDAs in the context of guidelines.
- 2.
- Semi-structured expert interviews will allow us to determine strategies for identifying guideline recommendations for which SDM is relevant and for successfully integrating SDM into guidelines.
- 3.
- We will conduct a Delphi study to determine how preference sensitivity can be defined and operationalized, and which criteria are relevant for prioritizing key questions in guidelines.
- 4.
- We will develop the tool: a list of items to identify guideline recommendations for which SDM seems most relevant will be created, tested and iteratively refined. In parallel, we will develop a user manual.
- 5.
- A platform for semi-automated production and online publication of PDAs will complement the tool development.
- 6.
- We will test the tool on 12–15 guidelines currently under development or revision. The tool will be optimized based on the testing.
Results: As of March 2024, we are conducting the scoping review (i.e. step 1). The preliminary results of the included studies (n = 24) show that the strength of the recommendation is often used as a criterion for the extent to which SDM is considered relevant. However, we found additional factors for selecting SDM-relevant recommendations. Other methods identified concern (i) a collaborative development of guidelines and PDAs based on the same evidence, (ii) an iterative process of user testing and quality assessment of PDAs, and (iii) linking/cross-referencing PDAs in guidelines and vice versa.
Implication for research and healthcare practice: The subsequent expert interviews (i.e. step 2) aim to fill the research gaps identified in the scoping review. Combining the results obtained in steps 1 to 3 will provide a rich methodological basis for the subsequent tool development carried out in step 4. Once developed, the tool will enable guideline developers to systematically incorporate SDM aspects and related tools into guideline development. Together, the tool and the PDA platform will create a systematic link between guidelines and PDAs, which may facilitate the implementation of SDM, a critical component of patient-centered care, in practice.
Funding: Innovationsfonds/Versorgungsforschung; Project name: EDELL– Entwicklung und Testung eines Instruments zum Einbezug von Shared Decision Making in Leitlinien; Grant number: 01VSF23022
