Table 6 Fidelity and adaptations
|  |  | 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) |