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113 Factors influencing shared decision-making on hospital wards as perceived by clinical nurses and physicians: a qualitative study
  1. Janita Bakker1,
  2. Elke M Huntink2,
  3. Loes J Peters3,
  4. Ilja M Brugman3,
  5. Dirk T Ubbink3,
  6. Lisette Schoonhoven2
  1. 1Department of Oncology, Isala, Zwolle, The Netherlands
  2. 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  3. 3Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam
  4. *contributed equally as first author
  5. **both qualify as last author

Abstract

Introduction The majority of studies into Shared Decision-Making (SDM) experiences have been conducted in outpatient settings. Limited insight exists regarding how healthcare professionals (HCPs) perceive SDM with patients on hospital wards. The aim of this study was to investigate the motivations among HCPs for applying SDM and which factors influence SDM on hospital wards.

Methods An explorative qualitative design including semi-structured interviews with clinical nurses, nurse specialists, physicians assistants and physicians working on a hospital ward. Setting was twelve different hospital wards of two university medical centres and one tertiary care hospital in the Netherlands.

Results 23 HCPs were interviewed. All HCPs stated to be motivated to apply SDM in the healthcare process of patients admitted to a hospital ward. Motivations were to provide high-quality care, focus on patient-centered care, incremental empowerment and professional innovation. Influencing factors were categorized in three items: organizational factors (a clear vision, the configuration of the ward round, time and the hospital organizational structure), Patient-related factors (severe illness, participation of relatives, familiarity with SDM and perceptual differences) and HCP-related factors (workload, novice HCP or limited expertise, continuity of care, interprofessional communication, contrast between education and practice).

Discussion To facilitate SDM, it is beneficial to embed SDM in the inpatient setting in which both physicians and nurses play an essential role. The distinction between medical treatment decisions and care decisions regarding SDM needs to be further investigated.

Conclusion All HCPs acknowledge the significance of SDM in the healthcare process due to its ability to improve the quality of care and prioritize patient-centered approaches. However, HCPs often encounter challenges in effectively applying SDM in this setting. To facilitate SDM, it is beneficial to embed SDM in the inpatient setting and establish a clear structure for interprofessional SDM in which both physicians and nurses play an essential role.

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