Integrating Shared Decision Making and Decision Support Tools into Clinical Practice Guidelines: What Does It Take? A Qualitative Study

Medical Decision Making, vol. 46, pp. 60–75

Abstract

Background. Awareness of shared decision making (SDM) is growing, but its integration into clinical practice guidelines (CPGs) remains challenging. We sought expert insights to identify strategies for more successfully integrating SDM and decision support tools into CPGs. Specifically, our objectives were to determine 1) how to identify CPG recommendations where SDM is most relevant and 2) what factors in CPG development hinder or facilitate the consideration of SDM and the development of decision support tools. Methods . We conducted semi-structured interviews with experts on CPGs and SDM. We analyzed the data using Mayring’s qualitative content analysis. Results. The 16 interviewed participants proposed several determinants of and strategies for identifying SDM-relevant recommendations. The most frequently mentioned determinant was “multiple options with benefits and harms where choices depend on individual preferences.” The most frequently mentioned strategy was prioritization, similar to the CPG scoping phase. Participants highlighted the role of patient partners in facilitating the consideration of SDM in CPG development but noted that a supportive culture toward both patient and public involvement and SDM is needed. The absence of standardized methods and inadequate resources hinder the consideration of SDM and the combined development of CPGs and decision support tools. The current format of CPGs was deemed overwhelming, while the inclusion of choice awareness in CPG recommendations could facilitate SDM. Conclusions. The identified strategies provide a starting point for CPG organizations to explore ways for integrating SDM and decision support tools into CPGs while considering context-specific barriers and facilitators. Implications. Further research is needed to assess the usefulness and feasibility of the proposed strategies. New policies and stronger collaboration between CPG and SDM communities appear to be needed to address identified barriers. Highlights We explored expert knowledge and experience on how to successfully integrate shared decision making (SDM) and decision support tools into clinical practice guidelines (CPGs). A combined development of CPGs and decision support tools was deemed essential; however, development processes often remain separate, with the CPG development group unaware of the decision support tool development group, and vice versa. In addition to stating choice awareness in CPGs, participants highlighted the critical role of patient partners in considering SDM in CPG development, but resource issues and a culture that neglects patient involvement and SDM remain. For CPG development groups to consider SDM and for health care professionals to practice it, things need to be as easy as possible.

Authors 16

1. Lena Fischer corresponding

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany

   Institute for Health Services and Health System Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany

2. Rahel Wollny

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Institute for Health Services and Health System Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany

3. Leon Vincent Schewe
   Affiliation as printed

   SHARE TO CARE, Patient-Centered Care GmbH, Cologne, Germany

4. Fueloep Scheibler

   University Hospital Schleswig-Holstein

   Affiliation as printed

   National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany

   SHARE TO CARE, Patient-Centered Care GmbH, Cologne, Germany

5. Torsten Karge
   Affiliation as printed

   CGS Clinical Guideline Services GmbH, Kiel, Germany

   Division of Gastroenterology, Infectiology and Rheumatology, Charite-Universitätsmedizin, Kiel, Germany

6. Thomas G. Langer
   Affiliation as printed

   German Network for Evidence-Based Medicine, Berlin, Germany

7. Corinna Schaefer
   Affiliation as printed

   German Health Literacy Network, Cologne, Germany

8. Iván D. Flórez

   Universidad de Antioquia · McMaster University

   Affiliation as printed

   Department of Pediatrics, University of Antioquia, Medellin, Colombia

   Pediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellin, Colombia

   School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada

9. Andrew Hutchinson

   National Institute for Health and Care Excellence

   Affiliation as printed

   National Institute for Health and Care Excellence (NICE), Manchester, UK

10. Sheyu Li

    Sichuan University · West China Hospital of Sichuan University

    Affiliation as printed

    Department of Endocrinology and Metabolism, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China

11. Marta Maes‐Carballo

    Universidade de Santiago de Compostela · Complejo Hospitalario de Ourense

    Affiliation as printed

    Deontological Committee of the College of Physicians of Ourense, Ourense, Spain

    Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain

    General Surgery Department, Hospital Público de Verín, Ourense, Spain

    Healthcare Ethics Committee of Ourense, Ourense, Spain

12. Zachary Munn

    The University of Adelaide

    Affiliation as printed

    Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, University of Adelaide, Adelaide, Australia

13. Lilisbeth Perestelo‐Pérez

    Servicio Canario de la Salud

    Affiliation as printed

    Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain

    Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain

    Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain

14. Livia Puljak

    Catholic University of Croatia

    Affiliation as printed

    Center for Evidence-Based Medicine and Healthcare, Catholic University of Croatia, Zagreb, Croatia

15. Anne Margarethe Stiggelbout Aachen Medical Decision Making Department of Biomedical Data Sciences

    Leiden University Medical Center

    Affiliation as printed

    Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands

16. Dawid Pieper

    Medizinische Hochschule Brandenburg Theodor Fontane

    Affiliation as printed

    Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany

    Institute for Health Services and Health System Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany