Development and testing of a tool to foster shared decision-making between patients and health care professionals in clinical practice guidelines

Oral
2024 Prague [Global Evidence Summit]
Fischer L1, Florez I2, Karge T3, Langer T4, Li S5, Maes-Carballo M6, Munn Z7, Perestelo-Perez L8, Pieper D1, Puljak L9, Schaefer C10, Scheibler F11, Schewe L12, Stiggelbout A13
1Institute For Health Services And Health System Research, Faculty Of Health Sciences Brandenburg, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
2Department of Pediatrics, University of Antioquia, Medellin, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Canada
3CGS Clinical Guideline Services GmbH, Berlin, Germany
4German Network for Evidence-based Medicine, Office of the German Guideline Program in Oncology (GGPO), Berlin, Germany
5Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
6General Surgery Department. Hospital Público Verín, Ourense, Spain; Department of General Surgery. University of Santiago de Compostela, Santiago de Compostela, Spain
7Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, University of Adelaide, Adelaine, Australia
8Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
9Center for Evidence-Based Medicine and Healthcare, Catholic University of Croatia, Zagreb, Croatia
10German Agency for Quality in Medicine (ÄZQ) , Berlin, Germany
11National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany; SHARE TO CARE. Patient-centered care GmbH, Cologne, Germany
12SHARE TO CARE. Patient-centered care GmbH, Cologne, Germany
13Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
BACKGROUND: Shared decision-making (SDM) is advocated to take into account patients' values and preferences into medical decision-making, particularly for preference-sensitive recommendations in clinical practice guidelines (CPGs). Patient decision aids (PDAs) play a central role in supporting the SDM process, and, in theory, create an inherently interrelated link between CPGs, SDM, and PDAs. In contrast, recent evidence suggests that CPGs are currently not well designed to support SDM. Integrating PDAs into SDM-relevant guideline recommendations may be a strategy to overcome these shortcomings and enable SDM through CPGs. However, there are currently no methods available to assist in the structured prioritization of guideline recommendations according to their relevance for SDM.

OBJECTIVE: To develop a tool enabling CPG developers to systematically identify and prioritize guideline recommendations that have a high relevance for SDM.

METHODS: The project consists of 6 steps. We conduct (1) a scoping review, (2) semistructured expert interviews, and (3) a Delphi study. This enables us to determine how SDM can be fostered in the context of CPGs, how preference sensitivity can be defined and operationalized, and which criteria are relevant for prioritizing key questions in CPGs. (4) To develop the tool, a list of relevant items to identify guideline recommendations that are most relevant for SDM is created, tested, and iteratively refined. (5) A platform for semi-automated production and online publication of PDAs complements the tool development. (6) We test the tool on 12 to 15 CPGs currently under development or revision and develop a user manual. The tool may be optimized based on the testing.

FUTURE PROSPECTS: The tool will offer CPG developers the opportunity to systematically incorporate aspects of SDM into CPG development. Together, the tool and the PDA platform will create a systematic link between CPGs, SDM, and PDAs by which SDM can be fostered in practice. Once translated, the tool has the potential to be used internationally.

RELEVANCE AND IMPORTANCE TO PATIENTS: Patient representatives are involved throughout the project. The tool will provide guideline-based support to health care professionals during patient interactions, which may facilitate the implementation of SDM, a critical component of patient-centered care, in practice.