Abstract：
OBJECTIVE: As part of a quality improvement initiative in the context of value-based health care we aimed to optimize the shared decision-making (SDM) process in the care pathway for Multiple Myeloma as part of a digital care pathway (DCP). For this, more insight was needed in health care professionals\' (HCPs\') perspectives on SDM, and how SDM elements could be addressed in a DCP for MM to facilitate HCPs\' performance of SDM.
METHODS: HCPs were interviewed as per the theory of planned behaviour and the model of organizational context and SDM (phase 1). Multidisciplinary development sessions were organized to discuss concepts of the solution with HCPs (phase 2). The solution was evaluated with two patients from the quality improvement team.
RESULTS: In phase 1, ten interviews were held. HCPs\' attitudes and the subjective norm towards SDM were positive, and the intention to perform SDM was high. The clinical environment (physical context, disease characteristics, assumptions about patient characteristics, and workflows) for MM posed challenges on the actual SDM behavior. Education and use of the DCP to create awareness of SDM were seen as possible facilitators for SDM. A prepared and active patient would facilitate the SDM process. In phase 2, three concept solutions were developed before arriving at the final solution. The final solution consisted of three elements to incorporate SDM steps in the DCP: 1) creating patient awareness and activation with two questions about their preferences prior to a consultation, 2) visualisation of preferences centrally in the DCP to trigger HCP to discuss them, 3) monitoring and improving SDM with patient-questionnaires after decision-making. Patients and HCPs were willing to implement it.
CONCLUSIONS: HCPs intention to engage in SDM was high, but their actual behaviour was challenged by the clinical environment. A 3-element DCP-based intervention was developed to increase SDM.
UNASSIGNED: Input on the solution was obtained from end-users including two patients and ten healthcare professionals.
METHODS: HCPs were interviewed as per the theory of planned behaviour and the model of organizational context and SDM (phase 1). Multidisciplinary development sessions were organized to discuss concepts of the solution with HCPs (phase 2). The solution was evaluated with two patients from the quality improvement team.
RESULTS: In phase 1, ten interviews were held. HCPs\' attitudes and the subjective norm towards SDM were positive, and the intention to perform SDM was high. The clinical environment (physical context, disease characteristics, assumptions about patient characteristics, and workflows) for MM posed challenges on the actual SDM behavior. Education and use of the DCP to create awareness of SDM were seen as possible facilitators for SDM. A prepared and active patient would facilitate the SDM process. In phase 2, three concept solutions were developed before arriving at the final solution. The final solution consisted of three elements to incorporate SDM steps in the DCP: 1) creating patient awareness and activation with two questions about their preferences prior to a consultation, 2) visualisation of preferences centrally in the DCP to trigger HCP to discuss them, 3) monitoring and improving SDM with patient-questionnaires after decision-making. Patients and HCPs were willing to implement it.
CONCLUSIONS: HCPs intention to engage in SDM was high, but their actual behaviour was challenged by the clinical environment. A 3-element DCP-based intervention was developed to increase SDM.
UNASSIGNED: Input on the solution was obtained from end-users including two patients and ten healthcare professionals.
摘要：
目的：作为基于价值的医疗保健质量改进计划的一部分，我们旨在优化多发性骨髓瘤护理路径中的共享决策(SDM)流程，作为数字护理路径(DCP)的一部分。为此，医疗保健专业人员(HCP)对SDM的观点需要更多的洞察力，以及如何在MM的DCP中处理SDM元素以促进SDM的HCP性能。
方法：根据计划行为理论以及组织环境和SDM模型对HCP进行了访谈（第1阶段）。组织了多学科开发会议，以讨论与HCP的解决方案概念（第2阶段）。对来自质量改进小组的两名患者进行了评估。
结果：在第一阶段，进行了十次访谈。HCP对SDM的态度和主观规范是积极的，并且执行SDM的意图很高。临床环境(物理环境，疾病特征，关于患者特征的假设，和工作流)对MM的实际SDM行为提出了挑战。教育和使用DCP来提高对SDM的认识被视为SDM的可能促进者。准备好并活跃的患者将促进SDM过程。在阶段2中,在达到最终解决方案之前开发了三个概念解决方案。最终的解决方案包括三个要素，将SDM步骤纳入DCP：1）在咨询之前，通过两个关于患者偏好的问题来创建患者意识和激活，2)在DCP集中可视化偏好，以触发HCP讨论它们，3)在决策后通过患者问卷监测和改进SDM。患者和HCP愿意实施它。
结论：HCP参与SDM的意愿很高，但他们的实际行为受到临床环境的挑战。开发了基于3元素DCP的干预措施以增加SDM。
■解决方案的输入来自最终用户，包括两名患者和十名医疗保健专业人员。
方法：根据计划行为理论以及组织环境和SDM模型对HCP进行了访谈（第1阶段）。组织了多学科开发会议，以讨论与HCP的解决方案概念（第2阶段）。对来自质量改进小组的两名患者进行了评估。
结果：在第一阶段，进行了十次访谈。HCP对SDM的态度和主观规范是积极的，并且执行SDM的意图很高。临床环境(物理环境，疾病特征，关于患者特征的假设，和工作流)对MM的实际SDM行为提出了挑战。教育和使用DCP来提高对SDM的认识被视为SDM的可能促进者。准备好并活跃的患者将促进SDM过程。在阶段2中,在达到最终解决方案之前开发了三个概念解决方案。最终的解决方案包括三个要素，将SDM步骤纳入DCP：1）在咨询之前，通过两个关于患者偏好的问题来创建患者意识和激活，2)在DCP集中可视化偏好，以触发HCP讨论它们，3)在决策后通过患者问卷监测和改进SDM。患者和HCP愿意实施它。
结论：HCP参与SDM的意愿很高，但他们的实际行为受到临床环境的挑战。开发了基于3元素DCP的干预措施以增加SDM。
■解决方案的输入来自最终用户，包括两名患者和十名医疗保健专业人员。
