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Shared Decision Making in Osteoarthritis Care: A pilot project with three demonstration sites across NSW

Lyndal TrevenaProfessor, Primary Heath CareFaculty of Medicine and HealthSchool of Public Health

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University of Sydney team Bond University team

Introducing the University team

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ACI Partnership

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ACSQHC National Standards

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Shared Decision Making Demonstration Sites: A Pilot Project

Project objectives

• Identify priority clinical issues for SDM implementation and ‘early adopter’ demonstration sites through ACI Networks, Taskforces and Institutes.

• Co-produce local SDM implementation strategies for up to three SDM demonstration sites

• Pilot test locally-relevant SDM implementation strategies over a 6 month period at each demonstration site

• Develop a greater understanding of some of the ‘real-world’ barriers and facilitators of SDM implementation

• Contribute to the first locally-generated evidence for SDM implementation to inform implementation on a wider scale in NSW Health

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Priority clinical issues and early adopter sites

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Osteoarthritis Chronic Care Program (OACCP)

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Three ‘early adopter’ sites

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National Strategies for Shared Decision Making (Coulter 2018)https://www.bertelsmann-stiftung.de/en/publications/publication/did/national-strategies-for-implementing-shared-decision-making-engl/

Nine countries selected from 22 included in a 2017 journal supplement

Countries (alphabetical)

• Australia, Canada, Denmark, Germany, Netherlands, Norway, Taiwan, United Kingdom, United States of America

Trevena L, Shepherd HL, Bonner C, Jansen J, Cust AE, Leask J, Shadbolt N, Del Mar C, McCaffery K, Hoffmann T. Shared decision making in Australia in 2017. ZEvid Fortbild Qual Gesundhwes. 2017 Jun;123-124:17-20. doi:10.1016/j.zefq.2017.05.011. Epub 2017 May 18. Review. PubMed PMID: 28527638.

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Factors that influence implementation of SDM (focus external factors)

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Framework for national implementation of SDM (informed by the Behaviour Change Wheel and Theoretical Domains Framework)

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Definition of Shared Decision Making

Shared decision making (SDM) is a process in which clinicians (doctors, nurses, therapists and other health professionals) and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties (often, but not always, assisted by the use of patient decision aids (PDAs)), together with decision support counselling and a systematic approach to recording and implementing patients’ preferences. (1)It brings together evidence-based practice AND person-centred care(1) Stiggelbout AM, Van der Weijden T, De Wit MP, Frosch D, Légaré F, Montori VM, Trevena L, Elwyn G. Shared decision making: really putting patients at the centreof healthcare. BMJ. 2012 Jan 27;344:e256. doi: 10.1136/bmj.e256. PubMed PMID:22286508.

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2nd edition OA management guidelines published July 2018

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A suite of tools and concepts were explored with each site

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Lessons from other countries (Coulter)

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Lessons from other countries (cont’d)

Challenges Potential Solutions

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What next?.....

– Complete the co-design for the three sites– Ethics and site-specific approvals– Implement over six months– Evaluate (mixed methods)

– Lessons learned will be considered for other OACCP sites and for other programs