BARRIERS AND FACILITATORS OF IMPLEMENTING SHARED DECISION MAKING AND DECISION SUPPORT IN A PEDIATRIC HOSPITAL: A DESCRIPTIVE STUDY

Purpose: To explore multiple stakeholders’ perceived barriers and facilitators of implementing shared decision making and decision support in a tertiary pediatric hospital.

Method: We conducted an interpretive descriptive qualitative study using focus groups and interviews to examine senior hospital administrators’, healthcare providers’, parents’, and children’s perceived barriers and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis.

Result: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was that stakeholders had minimal prior knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and our hospital’s culture, perceptions of positive patient and family outcomes with shared decision making, and positive attitudes about shared decision making and decision support. Youth’s attitude toward shared decision making and decision support surfaced as a barrier. The suitability of shared decision making and decision support for specific clinical situations and the impact of our decision support program on the clinical process were both barriers and facilitators.

Conclusion:  A multiple-stakeholder barrier and facilitator assessment informed our implementation strategy and resulted in stakeholder support for our program. Specific knowledge translation strategies that match barriers identified by each stakeholder group may promote successful shared decision making and decision support implementation.