Shared decision making implementation: a case study analysis to increase uptake in New South Wales.

In New South Wales (NSW) from 1996 to 2006, only 34-37% of newly diagnosed cancer patients were treated with radiotherapy instead of the 50% proposed by NSW Health in Radiotherapy Plans released in 1991, 1995 and 2003. As a consequence, over 50 000 cancer patients were not treated and has resulted in the estimated premature death of over 8000 patients and over 40 000 years of life lost. In 2008, there were 42 linear accelerators in NSW rather than the 62 recommended. Based on cancer incidence projections, NSW will require 69 linear accelerators in 2012--a shortfall of 27 linear accelerators. Already 15 linear accelerators have been approved. NSW Health has funding for seven extra linear accelerators, and eight extra linear accelerators are to be funded by the private sector. To make up the shortfall, a 'Catch Up' Plan is proposed for an additional 12 linear accelerators by the end of fiscal year 2012. This is estimated to cost $200 million over 4 years for one-off establishment costs for buildings and equipment plus $50 million per year for recurrent operating costs such as staff salaries. The 'Catch Up' Plan will create five new departments of radiation oncology in country hospitals and three new departments in metropolitan hospitals. These will be in addition to those already approved by NSW Health and will markedly improve access for treatment and result in an improvement in cancer survival. This significant increase in departments and equipment can only be achieved by the creation of an NSW Radiotherapy Taskforce similar to that proposed in the Baume report of 2002, 'A vision for radiotherapy'. Even if the 'Catch Up' Plan bridges the gap in service provision, forward planning beyond 2012 should commence immediately as 76 linear accelerators will be required for NSW in 2015 and 81 linear accelerators in 2017.

ProblemFieldwork is a vital component of public health emergency response, yet little has been published on undertaking fieldwork safely. Safety is of particular importance with emerging pandemic viruses, which can pose additional risks to public health fieldwork staff.ContextDuring a pandemic, surge health staff may be drawn from diverse professional backgrounds; they may have limited experience in fieldwork or be unfamiliar with the risks posed by a novel virus. Novel pathogens pose dangers to fieldwork staff, particularly when there are global or local shortages of personal protective equipment.ActionDuring the coronavirus disease 2019 (COVID-19) pandemic, New South Wales (NSW) Health’s Public Health Emergency Operations Centre (PHEOC) deployed staff for fieldwork in a range of settings. The PHEOC developed a protocol to systematize planning, risk assessment and management for COVID-19 fieldwork. The protocol was accompanied by training, discussion exercises and debriefs to support PHEOC fieldwork staff.Lessons learnedEffective fieldwork is an essential component of outbreak investigation and management, including stakeholder management. Here, we share and discuss key elements of the NSW Health protocol to support fieldwork during outbreak responses for emerging communicable diseases across various resource contexts. Limited understanding of novel viruses, particularly in the early phases of a pandemic, must be considered in decisions to deploy fieldwork staff and implement precautionary risk mitigation approaches. Planning is essential to protect staff and ensure ethical allocation of resources. Through appropriate selection of teams and training, surge staff can be supported to effectively conduct fieldwork.

Shared decision making (SDM) is now accepted as an evidence-based practice. However, its implementation has lagged. To date, SDM implementation efforts have comprised both direct efforts to incorporate core SDM principles into clinicians’ communication patterns and efforts to implement other interventions, like patient decision aids, as mechanisms that facilitate SDM. Applying implementation science to SDM implementation offers opportunities to improve SDM implementation efforts through systematic identification of barriers and facilitators and the application of evidence-based implementation strategies. Examples of successful SDM implementation strategies to date include practice facilitation/coaching, revising clinical team members’ roles to redistribute workloads, training of the clinical team, and cyclical small tests of change. Next steps for the field include comprehensive description of implementation strategies in reports of SDM implementation efforts, more attention to patients as interested and involved parties in SDM implementation, and more widespread availability of evidence-based tools (e.g. patient decision aids) that support SDM across clinical contexts.

The New South Wales (NSW) Health Department and the Ambulance Service of NSW introduced a trauma bypass system in Sydney on 29 March 1992. This study aims to review the outcomes of trauma bypass patients brought to St George Hospital, a major trauma service in south-eastern Sydney, and to assess the performance of the current prehospital trauma triage protocol. The St George Hospital Department of Trauma Services prospectively collected data on all trauma bypass patients for the 8-year period from 29 March 1992 to 29 March 2000. A total of 1990 patients were brought to hospital on trauma bypass. The average age was 32 years, 70% were men and 66% were from road traffic accidents. The positive predictive value of the prehospital triage tool for serious injury (Injury Severity Score [ISS] > 15) was 18.6% (95% CI 16.9-20.4). This is well below the benchmark previously established by the NSW Health Department Trauma System Advisory Committee. For all trauma bypass patients, 33.8% (95% CI 31.7-35.9) were discharged home from the ED. The overall death rate was 2.5% (95% CI 1.9-3.3). According to the proposed benchmark, current prehospital trauma triage guidelines are underperforming. This suggests that a review of the benchmarks of current local trauma systems and of the trauma triage tool is required.

The NSW Health COVID-19 Research Program was established in April 2020 to contribute to minimising the health, social and economic impacts of the coronavirus disease 2019 (COVID-19) pandemic in New South Wales (NSW). This paper describes the establishment and implemention of one element of the Program, the Emergency Response Priority Research (Emergency Response) workstream, which is focused on the rapid creation of evidence to support urgent operational work for the public health management of COVID-19 in NSW. Narrative description. As at June 2021, nine Emergency Response projects had been funded. Mechanisms used to expedite projects included: embedding academic researchers in NSW Health to work directly with routinely collected NSW Health data; adapting existing research projects to include a COVID-19 component; leveraging established research partnerships to conduct rapid pilots; and directly commissioning urgent projects with experienced and trusted local researchers. Evidence from Emergency Response projects has contributed directly to informing the NSW public health response. For example, findings from a study of COVID-19 transmission in schools and childcare settings in the early stages of the pandemic informed decisions around the resumption of on-campus education in 2020 and helped shape policy around higher risk activities to help reduce transmission in education settings. Similarly, findings from a project to validate methods for identifying SARS-CoV-2 virus fragments in wastewater were subsequently incorporated into the NSW Sewage Surveillance Program, which continues to provide NSW Health with information to support targeted messaging and testing. The approach to establishing and implementing the Emergency Response workstream highlights the importance of continuing to ensure a well-trained public health research community and actively supporting a collaborative research sector.

Shared decision making for high-risk surgery

BackgroundA patient decision aid (PDA) is a tool for shared decision making (SDM), which emphasises patient empowerment. It is useful in chronic diseases and when there are multiple, no best...

<h3>Background</h3> A patient decision aid (PDA) is a tool for shared decision making (SDM), which emphasises patient empowerment. It is useful in chronic diseases and when there are multiple, no...

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

Shared decision making (SDM) is a collaborative process involving both healthcare providers and patients in making medical decisions, which gains increasing prominence in healthcare practice. But evidence on the level of SDM in medical practice and barriers as well as stimulus during the SDM implementation among aesthetic dermatologists is limited in China. From July to August 2023, 1938 dermatologists were recruited online in China. Data were collected through an electronic questionnaire covering: (1) demographic features; (2) SDM questionnaire physician version (SDM-Q-Doc); and (3) stimulus and barriers in SDM implementation. Logistic regression was applied to explore factors associated with SDM practice, barriers, and stimulus of SDM implementation, respectively. The 1938 dermatologists included 1329 females (68.6%), with an average age of 35 years. The total SDM score ranged from 0 to 45, with a median value of 40 (IQR: 35-44), and the median stimulus score and barriers scores were 28 (IQR: 24-32) and 19 (IQR: 13-26), respectively. The prevalence of good SDM was 27.2%, logistic regression indicated that female dermatologists (odds ratio, OR=1.21, 95% confidence interval, CI: 0.96-1.51), and dermatologists with more years of aesthetic practice had a higher proportion of good SDM practice (OR was 1.44 for 5-9 years, 1.58 for 10-15 years and 1.77 for over 15 years). Moreover, female dermatologists and dermatologists with higher education level and serviced in private settings had lower barrier scores; female dermatologists and dermatologists with more years of aesthetic practice had higher stimulus scores. Chinese aesthetic dermatologists appear to implement SDM at an active level, with more stimulus and less barriers in SDM implementation. The integration of SDM into clinical practice among dermatologists is beneficial both for patients and dermatologists. Moreover, SDM practice should be strongly promoted and enhanced during medical aesthetics, especially among male dermatologists, dermatologists with less working experience, and those who work at public institutions.

The New South Wales (NSW) Public Health Act 2010 requires water suppliers to implement a drinking water quality assurance program that addresses the 'Framework for management of drinking water quality' in the Australian drinking water guidelines. NSW Health has recognised the importance of a staged implementation of this requirement and the need to support regional water utilities. To date, NSW Health has assisted 74 regional utilities to develop and implement their management systems. The Public Health Act 2010 has increased awareness of drinking water risk management, and offers a systematic process to identify and control risks. This has benefited large utilities, smaller suppliers, and remote and Aboriginal communities. Work is continuing to ensure implementation of the process by private suppliers and water carters.

Patient decision aids (PDAs) are evidence-based tools that facilitate shared decision-making (SDM) between patients and healthcare professionals. These tools are used when multiple treatment options exist, no clear choice prevails regarding risks versus benefits, and the best option may vary depending on patient values. A 2024 Cochrane review of 209 randomized controlled trials involving over 107,000 participants identified the substantial benefits of PDAs,1 including improved patient knowledge, increased SDM and enhanced accuracy of risk perceptions and alignment of decisions with patient values. Given these benefits, SDM tools are more widely used. However, their quality remains inconsistent, potentially limiting their benefit.2-4 Dermatology is particularly suited to SDM, given the wide-ranging and ever-evolving treatment options for conditions that often convey a significant psychological burden. A literature review was conducted to assess dermatologic PDAs for adherence with reporting the development process according to the International Patient Decision Aids Standards (IPDAS) Collaboration.5-8 A comprehensive search using MEDLINE (via PubMed) and EMBASE identified articles on dermatological PDA development from 2014 to 2024. After screening 509 publications, 11 studies describing 14 PDAs across eight conditions, psoriasis (2), acne (1), superficial, low and high-risk basal cell carcinoma (4), vitiligo (1), actinic keratoses (3), metastatic malignant melanoma (1), lentigo maligna (1) and hidradenitis suppurativa (1), were included. Data extraction followed Coulter et al.'s9 template for documenting PDA development, focusing on adherence to IPDAS reporting standards. Most studies (10/11) were published in the last 5 years (2020–2024). All PDAs aimed to support patients with a treatment decision (Table 1). Clinical guidelines (5/14) and literature reviews (4/14) were the most common information sources. Five studies did not report this step. Digital PDAs were most common (6/14), although 4 studies only provided images of the PDA, without stating the format. While most PDAs (10/14) reported adhering to the IPDAS framework with an iterative process, only three included all the required development steps (Figure 1). Clinician needs assessments were infrequently conducted (4/14), with just three specifying numbers involved. In contrast, patient needs assessments were more consistently reported (9/14), although only six provided details on patient numbers. Alpha testing with patients was reported in nearly all studies (12/14), reflecting strong patient engagement, but 4 of these did not provide participant numbers, limiting insight into testing scope. Across the PDAs, patient involvement was nearly double that of clinicians, with a median of 20 (IQR = 33) versus 13 (IQR = 38). Patient participation ranged widely from 7 to 322 individuals, while clinician numbers ranged from 8 to 51. Notably, no patient or clinician numbers were reported for any step in the development of PDAs that did not use the IPDAS development framework. This review of dermatologic PDAs reveals that many lack key elements of the IPDAS development process, such as expert panel involvement, needs assessments and usability testing. While most PDAs were reported to align with the IPDAS framework, a substantial number lacked transparency in their development process which may explain the previously reported variations in dermatologic PDA quality.4 For PDAs to effectively support patient-centred SDM, they must undergo a thorough development process with broad user engagement as demonstrated by our research group's development of a PDA for multiple AKs.10 We suggest developers follow the streamlined IPDAS development framework outlined by Witteman et al.7 and Coulter et al.9 which emphasizes iterative development, evidence-based content and stakeholder engagement through minimal, medium and maximal approaches. These approaches ensure both patients and clinicians are included in all development phases and define a minimum required number for user involvement. Future research should prioritize adherence to these standardized development frameworks. The study was completed in partial fulfillment of a doctorate of medicine funded by a research grant from The City of Dublin Skin and Cancer Hospital Charity. The funders were not involved in the study design, data collection, data analysis or manuscript preparation. The authors declare no conflicts of interest. Not applicable. Not applicable. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Shared decision making (SDM) is a core element in the meeting between patient and healthcare professionals, but has proved difficult to implement and sustain in routine clinical practice. One of five Danish regions set out to succeed and to develop a model that ensures lasting SDM based on learnings from large-scale real-world implementation initiatives that go beyond the 'barriers' and 'facilitators' research approach. This paper describes this process and development of a generic implementation model, SDM:HOSP. This project was carried out in the Region of Southern Denmark with five major hospital units. Based on existing theory of SDM, SDM implementation, implementation science and improvement methodology, a process of four phases were described; development of conceptual elements, field-testing, evaluation, and development of the final implementation model. The conceptual elements developed aimed to prepare leaders, train SDM teachers, teach clinicians to perform SDM, support development of patient decision aids, and support systematic planning, execution and follow-up. Field testing was done including continuous participant evaluations and an overall evaluation after one year. Data from field testing and learnings from the implementation process, illustrated the need for a dynamic and easy adjustable model. The final SDM:HOSP model included four themes; i)Training of Leaders, ii) Training of Teachers and Clinicians, iii) Decision Helper, and iv) 'Process', each with details in three levels, 1) shared elements, 2) recommendations, and 3) local adaption. A feasible and acceptable model for implementation of SDM across hospitals and departments that accounts for different organizations and cultures was developed. The overall design can easily be adapted to other organizations and can be adjusted to fit the specific organization and culture. The results from the ongoing and overall evaluation suggest promising avenues for future work in further testing and research of the usability of the model.

Introduction Most STIs are managed in primary care settings in Australia, so the New South Wales (NSW) STI Programs Unit supports sexual health education of professionals in these settings. However each NSW undergraduate medical school curriculum is different and is inconsistently taught. To support some consistency in teaching, the Workforce Education Development Group (WEDG) University of Sydney (USyd) agreed to develop and implement a sexual health module for medical students using spaced education (Qstream). Spaced education has been shown to improve knowledge acquisition, increase long-term knowledge retention and change behaviour. Methods The University of NSW and USyd Medical School Academic Departments of General Practice agreed to pilot the module during undergraduate primary care clinical attachments. Sixteen clinical scenarios with questions, model answers, references, and links to key resources were developed. Results Forty two undergraduate medical students completed the pilot providing mostly positive feedback about the delivery method (interactive, daily reminders, retesting knowledge) and content (realistic clinical scenarios). The main criticism was the desire for more case studies to compliment or fill gaps in prior learning. The sexual health module is now offered during 5th and 6th year Primary Care attachments at UNSW and is a required learning activity during 3rd year Community Health block at USyd. From August 2014–March 2015, 88 students from UNSW have commenced the course with a 50% completion rate. From October – December 2014, all 61 medical students at USyd completed the course with 64% finding the course very helpful or helpful. Feedback since module implementation remains positive with mobile friendliness, reminders, gradual learning and scenario rationales all rated highly. Conclusion Spaced education has proven adaptable to sexual health education and was accepted as beneficial and a positive style of learning about sexual health. Other NSW undergraduate programs have now been offered the module. Disclosure of interest statement The NSW STI Programs Unit is funded by NSW Health. No pharmaceutical grants were received in the development of this project.

A prospective cohort study of shared decision making in lung cancer diagnostics: Impact of using a patient decision aid