Objective: To prioritize strategies to implement shared decision-making (SDM) in daily practice, resulting in an agenda for a nationwide approach. Methods: This was a qualitative, exploratory investigation involving: Interviews (N = 43) to elicit perceived barriers to and facilitators of change, focus group discussions (N = 51) to develop an implementation strategy, and re-affirmation through written feedback (n = 19). Professionals, patients, researchers and policymakers from different healthcare sectors participated. Determinants for change were addressed at four implementation levels: (1) the concept of SDM, (2) clinician and/or patient, (3) organizational context and (4) socio-political context. Results: Following the identification of perceived barriers, four strategies were proposed to scale up SDM: 1) stimulating intrinsic motivation among clinicians via an integrated programmatic approach, 2) training and implementation in routine practice, 3) stimulating the empowerment of patients, 4) creating an enabling socio-political context. Conclusion: Clinicians mentioned that applying SDM makes their job more rewarding and indicated that implementation in daily practice needs ground-up redesign. The challenge is to effectively influence the behavior of clinicians and patients alike, and adapt clinical pathways to facilitate the exploration of patient values. Practice implications: Stakeholders should connect nationwide initiatives to pool information, and make the healthcare system supportive of implementing SDM.

Implementation, Multilevel, Patient-centered care, Practice improvement, Shared decision-making
dx.doi.org/10.1016/j.pec.2018.06.021, hdl.handle.net/1765/109269
Patient Education and Counseling
Erasmus School of Health Policy & Management (ESHPM)

van Veenendaal, H, van der Weijden, T, Ubbink, D.T, Stiggelbout, A.M, van Mierlo, L.A. (Linda A.), & Hilders, C.G.J.M. (2018). Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation. Patient Education and Counseling. doi:10.1016/j.pec.2018.06.021