Aims: To explore clinicians’ perspectives regarding use of Supported Decision Making (SDM) among hospitalised patients with cognitive impairment and to identify barriers and enablers for implementation.
Methods: A qualitative approach with mixed purposive sampling was employed. Twenty-six senior hospital clinicians were invited to participate in semi-structured face-to-face or videoconference interviews and focus groups. Various disciplines were recruited from: consultant physicians, medical registrars, clinical nurses, and allied health (including occupational therapy, physiotherapy, social work, speech pathology and neuropsychology). Data from transcribed audio recordings were evaluated by thematic analysis framework.
Results: Senior clinicians had variable conceptual and practical understanding of SDM. Perceived barriers limiting SDM in the acute hospital were a lack of resources including clinician time and availability of quiet spaces for discussion. Also identified was the inconsistent approach by clinicians in assessment of capacity and respect for dignity in risk taking. Additionally, existing systems promoted substitute decision making due to absence of legal framework for SDM, external stakeholders’ requirements, and an organisational drive to discharge patients efficiently. Key enablers of SDM were meaningful engagement with patients, supported communication strategies, and interprofessional collaboration amongst the multidisciplinary team.
Conclusions: Overall there was a willingness and desire to use SDM among clinicians, however, several barriers exist at individual and institutional levels. Legislative change alone may be insufficient to successfully implement SDM in the acute hospital system and a multi-pronged approach to change is needed.