Most important factors for the implementation of shared decision making in sciatica care: ranking among professionals and patients

Stefanie N Hofstede, Leti van Bodegom-Vos, Manon M Wentink, Carmen L A Vleggeert-Lankamp, Thea P M Vliet Vlieland, Perla J Marang-van de Mheen, DISC study group, W J J Assendelft, L van Bodegom-Vos, W B van den Hout, P J Marang-van de Mheen, A M Stiggelbout, C L A Vleggeert-Lankamp, T P M Vliet Vlieland, L Voogt, P C A J Vroomen, Stefanie N Hofstede, Leti van Bodegom-Vos, Manon M Wentink, Carmen L A Vleggeert-Lankamp, Thea P M Vliet Vlieland, Perla J Marang-van de Mheen, DISC study group, W J J Assendelft, L van Bodegom-Vos, W B van den Hout, P J Marang-van de Mheen, A M Stiggelbout, C L A Vleggeert-Lankamp, T P M Vliet Vlieland, L Voogt, P C A J Vroomen

Abstract

Introduction: Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy.

Methods: 246 professionals (general practitioners, physical therapists, neurologists, neurosurgeons, orthopedic surgeons) (30% response) and 155 patients (96% response) responded to an internet-based survey. Respondents ranked barriers and facilitators identified in previous interviews, on their importance using Maximum Difference Scaling. Feeding back the personal top 5 most important factors, each respondent indicated whether these factors were barriers or facilitators. Hierarchical Bayes estimation was used to estimate the relative importance (RI) of each factor.

Results: Professionals assigned the highest importance to: quality of professional-patient relationship (RI 4.87; CI 4.75-4.99); importance of quick recovery of patient (RI 4.83; CI 4.69-4.97); and knowledge about treatment options (RI 6.64; CI 4.53-4.74), which were reported as barrier and facilitator. Professionals working in primary care had a different ranking than those working in hospital care. Patients assigned the highest importance to: correct diagnosis by professionals (barrier, RI 8.19; CI 7.99-8.38); information provision about treatment options and potential harm and benefits (RI 7.87; CI 7.65-8.08); and explanation of the professional about the care trajectory (RI 7.16; CI 6.94-7.38), which were reported as barrier and facilitator.

Conclusions: Knowledge, information provision and a good relationship are the most important conditions for SDM perceived by both patients and professionals. These conditions are not restricted to one specific disease or health care system, because they are mostly professional or patient dependent and require healthcare professional training.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Inclusion and response of professionals.
Figure 1. Inclusion and response of professionals.
Figure 2. Preferences and practice of decision…
Figure 2. Preferences and practice of decision making in sciatica care according to professionals and patients.
Patient's decision: Patient makes the final selection about treatment. Shared decision: the doctor and patient share responsibility for deciding which treatment is best for the patient. Professional's decision: the doctor makes the final decision about treatment.

References

    1. Konstantinou K, Dunn KM (2008) Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976) 33: 2464–2472.
    1. Vroomen PC, de Krom MC, Knottnerus JA (2002) Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract 52: 119–123.
    1. Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW (2008) Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 336: 1355–1358.
    1. Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, et al. (2011) Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J 20: 513–522.
    1. Quality Institute for Health Care CBO (2008) Guideline Lumbosacral Radicular Syndrome (in Dutch). Utrecht: Quality Institute for Health Care CBO.
    1. Elwyn G, Laitner S, Coulter A, Walker E, Watson P, et al. (2010) Implementing shared decision making in the NHS. BMJ 341: c5146.
    1. Van Beek E, Lemmers K, Van Schooten G, Vlieger E (2010) Reduction of variation in clinical practice: budgetary effects of more precise indications (in Dutch). PLEXUS.
    1. Cherkin DC, Deyo RA, Loeser JD, Bush T, Waddell G (1994) An international comparison of back surgery rates. Spine (Phila Pa 1976) 19: 1201–1206.
    1. Veroff D, Marr A, Wennberg DE (2013) Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Aff (Millwood) 32: 285–293.
    1. Legare F, Ratte S, Gravel K, Graham ID (2008) Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. Patient Educ Couns 73: 526–535.
    1. Gravel K, Legare F, Graham ID (2006) Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci 1: 16.
    1. Legare F, Stacey D, Gagnon S, Dunn S, Pluye P, et al. (2011) Validating a conceptual model for an inter-professional approach to shared decision making: a mixed methods study. J Eval Clin Pract 17: 554–564.
    1. Jessup RL (2007) Interdisciplinary versus multidisciplinary care teams: do we understand the difference? Aust Health Rev 31: 330–331.
    1. Hofstede SN, Marang-van de Mheen PJ, Wentink MM, Stiggelbout AM, Vleggeert-Lankamp CLA, et al. (2013) Barriers and facilitators to implement shared decision making in multidisciplinary sciatica care: a qualitative study. Implement Sci 8: 95.
    1. Degner LF, Sloan JA (1992) Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol 45: 941–950.
    1. Sawtooth Software I (2013) The MaxDiff System/version 8 Technical Paper. Sequim: WA, Sawtooth Software
    1. Cohen S, Orme B (2004) What's your preference? Marketing Research 16: 32–37.
    1. Cohen, Steven H., Markowitz P. (2002) Renewing market segmentation: Some new tools to correct old problems. Congress Proceedings, Amsterdam, the Netherlands.
    1. Wirth R, Wolfrat A (2011) Using MaxDiff for Evaluating Very Large Sets of Items: Introduction and Simulation-Based Analysis of a New Approach.
    1. Sawtooth Software I (2009) The CBC/HB System for Hierarchical Bayes Estimation Version 5.0 Technical Paper. Sequim: WA, Sawtooth Software
    1. Sawtooth Software I (2012) SSI Web v8.1: Software for Web Interviewing and Conjoint Analysis. Sequim: WA, Sawtooth Software
    1. Legare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, et al. (2010) Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 5: CD006732.
    1. O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, et al. (2009) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 10: CD001431.
    1. Lurie JD, Berven SH, Gibson-Chambers J, Tosteson T, Tosteson A, et al. (2008) Patient preferences and expectations for care: determinants in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 33: 2663–2668.
    1. McIntosh E, Louviere JJ (2002) Separating weight and scale value: an exploration of best-attribute scaling in health economics. In Health Economists' Study Group meeting. Brunel University.
    1. Flynn TN, Louviere JJ, Peters TJ, Coast J (2007) Best-worst scaling: What it can do for health care research and how to do it. J Health Econ 26: 171–189.
    1. Webster BS, Courtney TK, Huang YH, Matz S, Christiani DC (2005) Physicians' initial management of acute low back pain versus evidence-based guidelines. Influence of sciatica. J Gen Intern Med 20: 1132–1135.
    1. Dobrow MJ, Orchard MC, Golden B, Holowaty E, Paszat L, et al. (2008) Response audit of an Internet survey of health care providers and administrators: implications for determination of response rates. J Med Internet Res 10: e30.
    1. Wiebe ER, Kaczorowski J, MacKay J (2012) Why are response rates in clinician surveys declining? Can Fam Physician 58: e225–e228.
    1. Raja R, Kingsbury SR, Wise E, Conaghan PG (2014) Primary care approaches to musculoskeletal multiple-site joint pain pharmacological therapy: a survey of general practitioners. Prim Health Care Res Dev 1–6.

Source: PubMed

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