Abstract:
BACKGROUND:The ethical argument that shared decision-making is "the right" thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as shared decision-making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for shared decision-making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The goal of this article is to hypothesize a wider set of consequences, that apply over an extended time horizon, and include outcomes at interactional, team, organizational and system levels, and to call for future research to study these possible consequences. MAIN ARGUMENT:To date, many more studies have evaluated patient decision aids rather than other approaches to shared decision-making, and the outcomes measured have typically been focused on short-term cognitive and affective outcomes, for example knowledge and decisional conflict. From a clinicians perspective, the shared decision-making process could be viewed as either intrinsically rewarding and protective, or burdensome and impractical, yet studies have not focused on the impact on professionals, either positive or negative. At interactional levels, group, team, and microsystem, the potential long-term consequences could include the development of a culture where deliberation and collaboration are regarded as guiding principles, where patients are coached to assess the value of interventions, to trade-off benefits versus harms, and assess their burdens-in short, to new social norms in the clinical workplace. At organizational levels, consistent shared decision-making might boost patient experience evaluations and lead to fewer complaints and legal challenges. In the long-term, shared decision-making might lead to changes in resource utilization, perhaps to reductions in cost, and to modification of workforce composition. Despite the gradual shift to value-based payment, some organizations, motivated by continued income derived from achieving high volumes of procedures and contacts, will see this as a negative consequence. CONCLUSION:We suggest that a broader conceptualization and measurement of shared decision-making would provide a more substantive evidence base to guide implementation. We outline a framework which illustrates a hypothesized set of proximal, distal, and distant consequences that might occur if collaboration and deliberation could be achieved routinely, proposing that well-informed preference-based patient decisions might lead to safer, more cost-effective healthcare, which in turn might result in reduced utilization rates and improved health outcomes.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Elwyn G,Frosch DL,Kobrin Sdoi
10.1186/s13012-016-0480-9subject
Has Abstractpub_date
2016-08-08 00:00:00pages
114issn
1748-5908pii
10.1186/s13012-016-0480-9journal_volume
11pub_type
杂志文章,评审abstract:BACKGROUND:In Belgium, the construction of the national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, healthcare providers, Evidence-Based Medicine (EBM) partners, and vend...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1748-5908-8-83
更新日期:2013-08-05 00:00:00
abstract:BACKGROUND:In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines-internalised and collectively reinforced tacit guidelines-rather than consulting written clinical guidelines. We considered how the concept of mindlines has been taken forward since. METHODS:We searched databases f...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-015-0229-x
更新日期:2015-04-09 00:00:00
abstract::As more quality improvement programs are implemented to achieve gains in performance, the need to evaluate their lasting effects has become increasingly evident. However, such long-term follow-up evaluations are scarce in healthcare implementation science, being largely relegated to the "need for further research" sec...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-21
更新日期:2008-04-22 00:00:00
abstract::As the recent collection of papers from the Quality Enhancement Research Initiative (QUERI) Series indicates, knowledge is leading to considerable action in the United States (U.S.) Department of Veterans Affairs (VA). The QUERI Series offers clinical researchers, implementation scientists, health systems, and health ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-13
更新日期:2009-03-06 00:00:00
abstract:BACKGROUND:Accurate measures of health professionals' clinical practice are critically important to guide health policy decisions, as well as for professional self-evaluation and for research-based investigation of clinical practice and process of care. It is often not feasible or ethical to measure behaviour through d...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-37
更新日期:2009-07-03 00:00:00
abstract:BACKGROUND:While it is recommended that childcare services implement policies and practices to support obesity prevention, there remains limited evidence to inform policy and practice. The aim of this study is to examine the effectiveness of performance review and facilitated feedback in increasing the implementation o...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13012-019-0865-7
更新日期:2019-02-18 00:00:00
abstract:BACKGROUND:Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other inte...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-1-23
更新日期:2006-10-18 00:00:00
abstract:BACKGROUND:Theories, models, and frameworks (TMF) are foundational for generalizing implementation efforts and research findings. However, TMF and the criteria used to select them are not often described in published articles, perhaps due in part to the challenge of selecting from among the many TMF that exist in the f...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0836-4
更新日期:2018-11-22 00:00:00
abstract:BACKGROUND:The continuing gap between available evidence and current practice in health care reinforces the need for more effective solutions, in particular related to organizational context. Considerable advances have been made within the U.S. Veterans Health Administration (VA) in systematically implementing evidence...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-30
更新日期:2008-05-29 00:00:00
abstract::This paper presents the rationale and methods for a randomized controlled evaluation of web-based training in motivational interviewing, goal setting, and behavioral task assignment. Web-based training may be a practical and cost-effective way to address the need for large-scale mental health training in evidence-base...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-7-43
更新日期:2012-05-14 00:00:00
abstract:BACKGROUND:Electronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-82
更新日期:2009-12-30 00:00:00
abstract:BACKGROUND:Antiretroviral therapy (ART) for HIV-infected persons and pre-exposure prophylaxis (PrEP) for uninfected persons are extraordinarily effective strategies for HIV prevention. In Africa, the region which shoulders the highest HIV burden, HIV care is principally delivered through public health HIV care clinics,...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-018-0809-7
更新日期:2018-09-04 00:00:00
abstract:BACKGROUND:The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational cha...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-9-53
更新日期:2014-05-02 00:00:00
abstract:BACKGROUND:Service development innovation in health technology and practice is viewed as a pressing need within the field of mental health yet is relatively poorly understood. Macro-level theories have been criticised for their limited explanatory power and they may not be appropriate for understanding local and fine-g...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-120
更新日期:2011-10-26 00:00:00
abstract:BACKGROUND:Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavil...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-017-0544-5
更新日期:2017-03-06 00:00:00
abstract:BACKGROUND:There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0479-2
更新日期:2016-08-08 00:00:00
abstract:BACKGROUND:National leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing so. However, little evidence exists to guide implementation of social determinants...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0855-9
更新日期:2019-01-28 00:00:00
abstract:BACKGROUND:The need to better understand processes of removing, reducing, or replacing healthcare services that are no longer deemed essential or effective is common across publicly funded healthcare systems. This paper explores expert international opinion regarding, first, the factors and processes that shape the suc...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-014-0123-y
更新日期:2014-09-10 00:00:00
abstract:BACKGROUND:Blood for transfusion is a frequently used clinical intervention, and is also a costly and limited resource with risks. Many transfusions are given to stable and non-bleeding patients despite no clear evidence of benefit from clinical studies. Audit and feedback (A&F) is widely used to improve the quality of...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-017-0614-8
更新日期:2017-07-03 00:00:00
abstract:BACKGROUND:Patients with chronic illness typically receive ambulatory treatment from multiple health professionals. Connectedness between these professionals may influence their clinical decisions and the coordination of patient care. We aimed to describe and analyze connectedness in a regional network of health profes...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-67
更新日期:2011-07-03 00:00:00
abstract:BACKGROUND:The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-8-95
更新日期:2013-08-23 00:00:00
abstract:BACKGROUND:Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/1748-5908-7-70
更新日期:2012-07-25 00:00:00
abstract:BACKGROUND:Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. T...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-1-8
更新日期:2006-03-31 00:00:00
abstract:BACKGROUND:Implementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funder...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-015-0290-5
更新日期:2015-07-17 00:00:00
abstract:BACKGROUND:Every safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthca...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0695-4
更新日期:2017-12-28 00:00:00
abstract:BACKGROUND:Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnai...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0837-3
更新日期:2018-12-12 00:00:00
abstract:BACKGROUND:In 2011, Manitoba implemented a province-wide program of physician detailing and free sampling for generic atorvastatin to increase use of this generic statin. We examined the impact of this unique combined program of detailing and sampling for generic atorvastatin on the use and cost of statin medicines, ma...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0671-z
更新日期:2017-11-25 00:00:00
abstract:BACKGROUND:While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication amo...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0456-9
更新日期:2016-07-07 00:00:00
abstract:BACKGROUND:Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-8-143
更新日期:2013-12-17 00:00:00
abstract:BACKGROUND:Experts recommend that alcohol-related care be integrated into primary care (PC) to improve prevention and treatment of unhealthy alcohol use. However, few healthcare systems offer such integrated care. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington (KPWA...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-018-0795-9
更新日期:2018-08-06 00:00:00