Shared decision-making supported by outcome information in stroke care

This thesis investigates how shared decision-making (SDM) supported by personalized outcome information can enhance value-based stroke care. SDM, which involves aligning clinical evidence with patient preferences, holds promise for improving care quality, yet its application in stroke care remains limited. This thesis explores how personalized outcome information can support SDM, focusing on patient experiences, the development and implementation of a patient decision aid (PtDA), and healthcare professionals’ perceptions of SDM in stroke care.

§  Chapter 2: a systematic review of 11 studies (896 participants) found that existing decision support tools modestly improved decision quality and reduced decisional conflict, though standardized SDM assessments were lacking.

§  Chapter 3: in the acute phase of stroke care, half of 72 surveyed patients preferred active involvement, but only 21% felt engaged, revealing communication gaps about treatment options.

§  Chapter 4: a PtDA for discharge planning was developed and shown to be user-friendly, featuring personalized outcome information.

§  Chapter 5 and 6: the SHOUT-STROKE multicenter study (635 patients, seven hospitals) evaluated a multicomponent SDM intervention, including the PtDA, an accompanying implementation strategy and training for healthcare professionals. While overall SDM levels did not significantly improve, patient knowledge increased in two hospitals, and the PtDA was valued by patients.

§  Chapter 7: a process evaluation found variability in implementation rates and limited integration of the PtDA into clinical practice.

The thesis concludes that while SDM in stroke care seems feasible and valued by patients, its effective implementation requires better strategies to embed SDM interventions into routine clinical practice.