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Table 6 Fidelity and adaptations

From: Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

   SDM training for HCPs Individual coaching for physicians Patient activation strategy Provision of patient information material and decision aids Revision of the department’s quality management documents Critical reflection of current organization of MDTMs
Actor(s) Planned Trained HCPs of respective department (trained by research team in a train-the-trainer workshop), research team Research team Clinical staff and research team Clinical staff and research team Research team, quality management department, and head HCPs of each department Clinical staff and research team
Adaptations Research team led the trainings, trained HCPs less active than planned No adaptations Research team was main driver of dissemination Research team was main driver of dissemination Not all targeted actors from departments participated Partly expansion of targeted actors to additional departments involved in the respective MDTMs
Action(s) Planned Interdisciplinary SDM training for physicians and nurses Participant observation of physician-patient interaction and provision of feedback Dissemination of material encouraging patients to ask questions regarding treatment options Dissemination and use of information material and decision aids Inclusion of SDM in quality management documents Meetings with respective head of department and members of the clinical teams responsible for the MDTMs
Adaptations Only 32% of trainings were interdisciplinary; non-participants received training material by mail Sometimes limited realm of feedback due to encounters without decision-making Additional dissemination on department websites Additional dissemination on department websites; lack of decision-specific patient decision aids in German Additional development of a stand-alone quality management document on SDM Head of department 2 did not participate
Target(s) of action Planned HCPs working at respective department HCPs working at respective department Patients being treated in respective department Patients being treated in respective department All staff working at respective department All patient cases discussed in MDTMs
Adaptations No adaptations No adaptations No adaptations No adaptations No adaptations No adaptations
Temporality Planned Beginning of implementation phase in respective department First coaching should be within 4 weeks after training Throughout implementation phase in respective department with start at beginning of phase Throughout implementation phase in respective department with start after HCP training Beginning of implementation phase in respective department Throughout implementation phase in respective department
Adaptations No adaptations Some coaching sessions delayed or without prior training No adaptations No adaptations Delayed start, expansion of time frame Expansion of time frame
Dose Planned Two hours training Two coaching sessions with oral and written feedback per HCP Initial set up of material in different department areas, need-based restocking Initial set up of material in different department areas, need-based re-stocking Short oral presentation of new documents in team meetings, combined with email to staff members Two to three meetings of approx. 60 min per department
Adaptations Mean duration of team trainings 49.62 minutes Partly only one coaching session No adaptations No adaptations Oral presentations did not take place Less meetings than planned (n = 5 in total)
  1. Notes. SDM shared decision-making, HCPs health care professionals, MDTMs multidisciplinary team meetings