So far, robust evidence on which strategies are most effective in supporting SDM through guidelines is lacking. Therefore, the content of this chapter is mostly based on experience and expert opinion. To the best of our knowledge, there are no experimental studies on the performance of SDM in practice, in which a guideline with SDM strategies is compared with a guideline with ‘classic’ recommendations. However, because SDM is widely regarded as an ethical obligation to assure patient autonomy (Steckelberg et al. 2011), we strongly recommend the use of practices supporting SDM that align with a guideline developer’s resources and goals.
SDM for individual patients can be promoted through population-level guidelines using a broad range of methods. These comprise interventions aimed at patients (providing decision support tools) and at HCPs (increasing awareness, encouraging engagement in SDM, enabling adequate communication). Some of the strategies are rather simple and do not require much planning or resources (consider wording that encourages discussion); some are moderately resource demanding (presenting information on options, developing generic chapters, highlighting situations with specific demand for SDM, production of semi-automated decision aids); but some entail a lot of additional work (producing decision tools for the guideline and assuring their visibility in the whole guideline context, formulating recommendations on the use of decision aids, on SDM and goal setting). Guidelines are produced in various settings. Some are very constrained, others have broad opportunities and resources. See table 3 for a summary of the strategies to encourage SDM that are presented in this chapter.
Therefore, not every intervention presented in this chapter will be helpful in all settings. However, even small changes in guideline production may contribute to the aim of enabling SDM through guidelines.
Table 3 Summary of proposed strategies to encourage SDM
|Revise wording of recommendations||During guideline production||Guideline group||–|
|Present options and their benefit/harm profile in the guideline||During guideline production||Guideline Group, content management system support possible||+/-|
|Identify and systematically prioritise clinical situations needing SDM support||During guideline production||Guideline group||+|
|Provide either a generic chapter on SDM in guidelines or a specific SDM-guideline||Before or during guideline production||Guideline group or former guideline groups||+/++|
|Provide guideline-based decision support tools||During production or after publication||External teams, information specialists and medical writers, guideline group||+/++|
|Integrate SDM and decision aids into guideline algorithms and recommendations and provide SDM-tools as an integral part of the guideline||During guideline production||Guideline group, possibly supported by medical writers or others||++|