Purpose: The multidisciplinary Dutch sciatica guideline recommends shared decision making (SDM) of patients and professionals involved, to choose between prolonged conservative treatment and surgery after three months with persisting leg pain. Given strong indications that SDM is not integrated in daily practice yet, we explored the barriers and facilitators related to the everyday embedding of SDM for sciatica patients among all involved professionals.
Methods: Barriers and facilitators for SDM in sciatica care were identified using semi-structured interviews among all disciplines involved (general practitioners (GP), physical therapists (PT), neurologists, neurosurgeons, and orthopedic surgeons). In total 40 interviews were conducted (8 per discipline), written out in full and analyzed using the framework of Grol and Wensing (2004).
Results: More barriers than facilitators are perceived by professionals (table 1). An important barrier is that the concept of SDM is not clear; so that professionals think they are using SDM while in fact patients do not have a choice, and treatment choice is often based on professional preferences. Most professionals in primary care prefer conservative care, while specialists differ in preferences. Preferences can be based on a lack of knowledge about both treatment outcomes, especially in primary care. Financial interests can influence preferences of PTs and surgeons, because they can benefit from a certain treatment. A barrier noticed by especially the GP and neurologist is a lack of time for SDM. Another barrier is the lack of a clear structure for the point at which treatment choices are explained and by whom. This leaves it mainly up to the patient to deal with the variation in opinions between professionals, resulting in practice variation. A multidisciplinary deliberation can improve the structure. Conclusions: 
See more of: The 34th Annual Meeting of the Society for Medical Decision Making