Implementation of a patient decision aid for discharge planning of hospitalized patients with stroke: aprocess evaluation using a mixed-methods approach.

Abstract

To promote shared decision-making (SDM) during discharge planning of patients with stroke, a patient decision aid (PtDA) was implemented in seven Dutch hospitals. This mixed-methods process evaluation assessed: 1) PtDA use, 2) the SDM process, 3) facilitators and barriers influencing health care professional (HCP) adoption of the PtDA, and 4) HCP experiences with the PtDA. Rates of PtDA use were derived from hospital registries and PtDA log data. SDM levels in consultations were quantitatively assessed using OPTION-5 (score range 0-100); the SDM process was analyzed qualitatively. Facilitators and barriers were identified via the MIDI questionnaire. HCP experiences were explored through interviews. PtDA use varied across hospitals, with 10-96 % of patients receiving it and 27-100 % of those ultimately using it. OPTION-5 scores were low in both pre-implementation (n = 68, median:0, Q1-Q3:0-0) and post-implementation consultations (n = 49, median:0, Q1-Q3:0-15). Barriers included lack of whole-team engagement and limited recognition of PtDA benefits. Frequent PtDA use was associated with HCP confidence and self-efficacy in SDM. Successful PtDA implementation in stroke care requires whole-team engagement, emphasis on PtDA benefits, and enhancing HCP confidence and self-efficacy in SDM. Highlighting positive SDM outcomes and patient benefits may encourage HCPs to adopt the PtDA.