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Table 3 An implementation plan for shared decision making in the context of Down syndrome prenatal screening

From: Theory-based approach to developing an implementation plan to support the adoption of a patient decision aid for Down syndrome prenatal screening

Categories (EPOC categories)

Strategies to be implemented

Delivery arrangements

Coordination of care and management of care processes

Care pathways

Integrate into existing clinical pathways distribution of the DA, reading it, and discussing it with the health professional.

Shared decision-making

Prenatal care providers involve pregnant women in shared decision-making in their clinical practice and encourage their active participation in decision-making.

Continuity of care

In obstetrics-gynecology departments, assign follow-up prenatal screening for women who need more support to a designated decision coach.

Implementation strategies

Interventions targeting healthcare organizations

Organizational culture

- As this is not yet part of the organizational culture of prenatal care services, establish a multi-stakeholder steering committee to guide implementation that includes all types of health professionals involved in prenatal care, health managers, policymakers, researchers, and pregnant women and their partners.

- Develop a communication plan that promotes shared decision making and the use of the DA among prenatal care providers.

- Identify an OBGYN who can champion shared decision making and the use of the DA in hospital settings.

Interventions targeting healthcare workers

Educational materials

Distribute educational material to health professionals for the use with the woman and her partner during consultation, including paper-based DA.

Educational meetings

- Provide prenatal care providers with access to existing online training modules on shared decision making and the use of DAs in prenatal care. This training aims to improve their knowledge and skills on shared decision making, Down syndrome prenatal screening, decision aids, and communication between healthcare professionals and patients.

- Identify appropriate health professionals in hospital settings to train as decision coaches who will work with women, their partners, and OBGYNs to support prenatal care decision-making.

Inter-professional education

Provide health professionals in hospital settings with in-person training on inter-professional approaches to shared decision making.

Tailored interventions

Create a communication strategy tailored to promoting the use of the DA among health professionals working in hospital settings.

Interventions targeting patients

Distribution and use of decision aid

- Distribute DA on DS prenatal screening to all pregnant women.

- Make available free web-based version of the DA on credible websites.

- Make available video on the use of the DA to patients online for women with low literacy skills and for people who prefer animated to a written material.

- Invite each pregnant woman who receives the DA to consult it, to write down her questions and discuss them with her health care professional during the consultation.

Reminders

Develop and display posters in waiting room and consultation rooms. For services with a television screen in their waiting room, display messages on screen.

Routine patient-reported outcome measures

Following the use of the DA, collect patient-reported outcome measures such as such as knowledge, decisional conflict, decision regret, involvement of partner, and satisfaction among women who used it to make prenatal screening decisions.

  1. EPOC Effective Practice and Organisation of Care; DA Decision aid