Interprofessional Shared Decision-Making in Clinical Settings

Introduction to Interprofessional Engagement in Healthcare

Although no universal definition exists, interprofessional engagement can be regarded as the collaboration that occurs between professionals from different disciplines who work together to identify and solve problems and formulate treatment strategies. The engagement process is based on a teamwork approach that draws on the knowledge and experience of various fields to develop comprehensive solutions to frequently complex problems (Fang, 2023).

It is reasonable to suggest that humankind has relied on interprofessional engagement in some form since time immemorial, when different people were recognized as possessing prized skills not shared by many others. In a modern context, however, the history of interprofessional engagement can be traced to the late 1960s, when "teamwork became the cornerstone for effective collaboration as primary care centers" (Barr, 2019).

Interprofessional collaboration in healthcare settings allows professionals from diverse backgrounds to cooperate as a coordinated unit. This team-based approach draws on the unique talents and viewpoints of various disciplines to enhance patient care. Working together fosters mutual understanding and respect between team members. It also provides opportunities to learn best practices from one another, which facilitates the detection and prevention of medical errors while speeding intervention when risks emerge (The Importance of Interprofessional Collaboration in Healthcare, 2023).

Contributions from administrators, physicians, IT staff, and nurses facilitate the development of documentation tools, communication platforms, and data infrastructure to capture real-time patient insights at the bedside. By working within an interprofessional framework, nurses can help shape future best practices rather than simply adopting new policy guidelines (Clark et al., 2023).

Six Steps for Implementing Interprofessional Shared Decision-Making

Implementing interprofessional shared decision-making (SDM) within a clinical setting is a stepwise process intended to maximize the value of contributions from each team member by drawing on their respective areas of expertise, including doctors of nursing practice (DNPs). In this context, the DNP essentials outline core competencies for nursing's highest practice degree in order to equip nurses to be effective leaders and clinicians. Several of these essential areas specifically relate to DNP competencies for facilitating shared decision-making, as discussed further below.

Although a "core clinical team" comprised of healthcare professionals from relevant specialty areas — such as physicians, nurses, social workers, rehabilitation specialists, and case managers — is routinely used, every decision-making scenario and every patient is unique. Therefore, this step requires a careful assessment of which disciplines should be represented to achieve optimal clinical outcomes.

Persuading professionals of any background to leave their respective comfort zones by implementing changes to established policy and practice protocols can be a daunting enterprise. Prior to any proposal for practice change, policy proposers should ensure that the evidence supports the suggested changes through data analysis and literature reviews. In addition, careful assessment of the readiness for change among key players and the identification of any knowledge gaps should be performed, followed by targeted messaging concerning the expected benefits of the proposal for patients, providers, and the organization, in order to build buy-in among key players.

Because clinicians are busy professionals, extra efforts should be made to minimize disruption to current protocols, and ongoing feedback from representative interprofessional team members should be solicited. Recruiting champions from the represented disciplines — who can act as change advocates to their peers — and demonstrating management buy-in through the allocation of resources and funding will also be important elements of any practice change proposal. Finally, it is essential to develop clear implementation protocols and to schedule regular meetings before and after launch to identify problem areas and opportunities for improvement.

This step involves evaluating the common decisions for the target patient population and identifying where they occur within the process of care. While this step is fairly straightforward, it is also iterative, and multiple ethical issues can arise that may impact the decision to proceed with a quality improvement project. Most notable is the revelation of new evidence that may adversely affect the intended outcome of a quality improvement initiative. Such evidence may relate to newly released information concerning potential harms to patients, providers, or organizations that might result from implementing a given DNP initiative, or it may arise from empirical observations made by team members.

The approach taken when critical players lead to unwarranted practice variation depends on the severity and scope of that variation. If the severity and scope are minimal, collaboration between the DNP and the responsible provider concerning the need for a standardized, evidence-based approach may suffice. Conversely, if variations pose serious threats to patient or provider safety, the appropriate response would require a full team meeting as well as notification to appropriate management levels, including top leadership.

Implementing any DNP quality improvement initiative to enhance patients' knowledge and expectations — in ways that also improve patient-clinician communication — demands open lines of communication between healthcare providers and patients. The process begins with nurses asking patients open-ended questions to elicit their preferences, cultural and individual beliefs, and values about their treatment regimen, including their prescribed medications. Patients can then be provided with simple explanations of how their medications work, including potential side effects, a risks-and-benefits analysis, and available alternatives.

Patient Decision Aids and International Standards

Nurses should use teach-back methods to confirm patient understanding and document patients' priorities and preferences related to symptom management. Pre- and post-intervention data on patient activation levels, perceived involvement in decisions, medication adherence rates, and patient satisfaction can identify opportunities for improvement. This SDM-focused intervention channels essential nursing communication techniques to enhance patient autonomy through the provision of timely and relevant knowledge and the formation of a therapeutic rapport with healthcare providers (Marks et al., 2022).

The development of patient decision aids has expanded rapidly over recent years, with over 500 currently in existence following initial origins in academic settings. These tools are designed to supplement patient-provider discussions and help patients better understand treatment options while clarifying personal preferences. Research shows that decision aids can improve patient knowledge and realistic expectations regarding procedures and empower patient involvement in choices. However, there remains a lack of consensus around concepts, appropriate methodology, and quality control criteria for patient decision aids (Elwyn et al., 2006).

This limitation presents significant concerns, since variabilities and potential biases in these tools can substantially impact the options patients select. Recognizing this need, the International Patient Decision Aids Standards (IPDAS) Collaboration formed to develop an internationally accepted framework of quality indicators that patient decision aids should meet. Existing quality assessment checklists were reviewed, but a tailored tool was deemed necessary given how decision aids function as interventions that provide probability estimates to guide deliberation in preference-sensitive decisions. The IPDAS initiative represents an important effort to standardize development and evaluation measures for patient decision aids, both to assist practitioners and to properly inform end-users (Elwyn et al., 2006).

The alphabetic inventory of international standards for decision aids provides a useful — though not exhaustive — one-stop resource for locating relevant SDM aids and strategies for a wide array of healthcare purposes. One tool that closely correlates with a DNP project focused on dementia care is the decision aid for patients provided by the Mayo Clinic entitled "Alzheimer's disease: Should I take medicines?" available through the Ottawa Hospital Research Institute's decision aid library at decisionaid.ohri.ca.