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201 Shared decision-making on hospital wards: an observational study
  1. Loes J Peters1,2,
  2. Ilja M Brugman3,
  3. Elke M Huntink4,
  4. Janita Bakker5,
  5. Dirk T Ubbink1
  1. 1Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
  2. 2Dutch Association of Medical Specialists, Utrecht, the Netherlands
  3. 3Nivel: The Netherlands Institute for Healthcare Research, Utrecht, the Netherlands
  4. 4Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
  5. 5Department of Oncology, Isala Clinic, Zwolle, The Netherlands

Abstract

Introduction Current evidence on the application of Shared Decision-Making (SDM) merely draws from the outpatient setting. To gain understanding of its application in the inpatient setting, we investigated the current level of SDM on hospital wards among clinicians and their patients, and their knowledge about and experiences with SDM.

Methods In this explorative observational and interview study, we used non-participating observations and semi-structured interviews, conducted in twelve hospital wards in two university medical centers and one teaching hospital in the Netherlands. Hospitalized patients and healthcare professionals (HCPs; physicians, nurses and physician assistants) working on these wards participated. The different steps of SDM as observed by two researchers who visited the wards without exactly explaining their purpose were analyzed using the OPTION-5 items.

Results In total, 131 patients across wards of 10 different specialties and during 431 different interactions with their HCPs (daily rounds, vital signs checks, medication rounds, care moments) were observed. Subsequently, 13 patients and 23 HCPs participated in interviews. Although most HCPs were aware of the concept of SDM, only a minority could provide a correct definition. Most patients were unaware of what SDM entails. Observations revealed limited efforts by HCPs to involve patients in decision-making. During 56 interprofessional discussions observed, patient preferences were addressed for only 15 out of 57 (26%) decisions made.

Discussion Unlike the outpatient setting, SDM takes place in a more interprofessional manner and is related to both treatment and care. Improving SDM on hospital wards requires consideration of these dynamics.

Conclusions Knowledge of SDM among clinicians and patients, as well as the observed level of SDM on hospital wards were low.

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