Introduction Encouraging implementation of shared decision-making (SDM) has become priority in Dutch Healthcare.¹ Reflection on Dutch implementation studies enhancing SDM adoption in clinical practice, led to 5 key insights.

Methods The implementation studies:

1. Qualitative interview study with SDM frontrunners to develop a national implementation strategy²

2. Two before-after studies and regression analysis evaluating a multilevel implementation program in 11 breast cancer teams^{3 4}

3. followed by an evaluation among participating clinicians⁵

4. Systematic review on SDM and its effect on consultation duration⁶

5. Questionnaire revealing cancer patients ‘perceptions⁷

6. Design of a multicenter RCT testing a digital scalable learning intervention.⁸

7. Key messages from other recent Dutch implementation studies^9–16

Results The five insights:

1. Multilevel implementation is effective and feasible

2. Training, training, training

3. Learning is more important than (only) measuring

4. Patients and clinicians are merely humans

5. Do not forget the system

Discussion This selected studies were conducted close everyday reality, where application ultimately takes place. Limitations are that it relied on (OPTION-5) observations - sensitive to the evaluators’ interpretation,¹⁷ measurements were unblinded and highly motivated clinicians participated. Teams from 20 Dutch hospitals were involved, but usually 1 team per hospital. Faster adaptations of the (Dutch) healthcare system, sustainability of SDM improvements, empowering less health-literate groups and the role of time, need future investigation.

Conclusion(s) Theory-based, multilevel SDM implementation is effective. Let us decide together that SDM is challenging, fun, and normal, with equity and equality as guiding principles for healthcare improvement: equity to respond to differences between people, especially those who are vulnerable. And equality to cherish that decision-making processes will only lead to high-quality care if two people, each with their own expertise, authentically meet each other.

References

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