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255 Understanding clinicians’ adoption of shared decision- making: a framework analysis using diffusion of innovations theory
  1. Laura Spinnewijn1,
  2. Johanna WM Aarts2,
  3. Didi DM Braat1,
  4. Fedde Scheele3
  1. 1Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
  2. 2Department of Gynecological Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  3. 3Faculty of Science, Athena Institute, VU University, Amsterdam, The Netherlands


Introduction This study employed the Diffusion of Innovations (DOI) theory to comprehensively understand the adoption of shared decision-making (SDM) in clinical practice, specifically focusing on the ‘knowledge’ and ‘persuasion’ stages within DOI.1 The aim was to understand the challenges and dynamics associated with SDM adoption, offering insights for more patient-centered decision- making in healthcare.

Methods In this qualitative study, a modified framework analysis approach was employed,2 integrating ethnographic and interview data from prior research,3 4 along with additional interviews. The framework used was based on DOI theory.1 The study was conducted in the obstetrics and gynaecology department of a tertiary teaching hospital in the Eastern region of the Netherlands. It included interviews with 20 participants, including gynaecologists, registrars, and junior doctors currently practicing in the department. Additionally, data from prior research conducted within the same department were incorporated, ensuring the maintenance of contextual consistency.

Results Findings revealed a complex interplay between SDM’s benefits and challenges. Clinicians valued SDM for upholding patient autonomy and enhancing medical practice, viewing it as valuable for medical decision-making. Decision aids were seen as advantageous in supporting treatment decisions. Challenges included perceptions of SDM as time-consuming and difficult, compatibility issues between patient and clinician preferences, and constraints due to healthcare’s pace. Additionally, perceived complexity varied by situation, influenced by colleagues’ attitudes, with limited trialability and sparsely observed instances of SDM.

Discussion Clinicians’ decisions to adopt or reject SDM were multifaceted, shaped by beliefs, cognitive processes, and contextual challenges. Cognitive dissonance was critical,5 as clinicians reconciled their existing practices with the adoption of SDM.

Conclusion(s) To promote SDM adoption, practical strategies like practice assessments, open discussions about SDM’s utility, and encouraging reflective practice6 through professional development initiatives should be employed.


  1. Rogers EM. Diffusion of innovations. New York: Free Press 2003.

  2. Gale, NK, Heath, G, Cameron, E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.

  3. Spinnewijn L, Aarts J, Verschuur S, et al. Knowing what the patient wants: a hospital ethnography studying physician culture in shared decision making in the Netherlands. BMJ Open, 2020;10(3):e032921.

  4. Spinnewijn L, Bolte AC, Braat DDM, et al. Structurally collecting patient feedback on trainee skills: A pilot study in Obstetrics and Gynaecology. Patient Educ Couns. 2022;105(5):1276–82.

  5. Aronson E. The Evolution of Cognitive Dissonance Theory: A Personal Appraisal. Front Soc Psychol. 2007:115–35.

  6. Brigley S, Young Y, Littlejohns P, et al. Continuing education for medical professionals: a reflective model. Postgrad Med J. 1997;73(855):23–6.

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