Interprofessional Shared Decision Making in NICU: A Mixed Methods Study

Abstract

Background: The process of shared decision making (SDM), a key component of interprofessional (IP) practice, provides an opportunity for the separate and shared knowledge and skills of care providers to synergistically influence the client / patient care provided. The aim of this study was to understand how different professional groups perceive IPSDM, their role as effective participants in the process and how they ensure their voices are heard. Methods: A sequential explanatory mixed methods design was used consisting of a realist review of the literature about IPSDM in intensive care, a survey of the IP team (n=96; RR-81.4%) about collaboration and satisfaction with the decision making process in NICU, semi-structured interviews with a sample of team members (n=22) working in NICU, and observation of team decision making interactions during morning rounds over a two week period. A tertiary care NICU in Canada was the study setting. Findings: The study revealed a number of key findings that are important to our increased understanding of IPSDM. Healthcare professionals’ (HCP) views differ about what constitutes IPSDM. The nature of the decision (triage, chronic condition, values sensitive) is an important influencing factor for IPSDM. Four key roles were identified as essential to the IPSDM process: professional expert, leader, synthesizer and parent. IPSDM involves collaboration, sharing, weighing and building consensus to overcome diversity. HCPs use persuasive knowledge exchange strategies to ensure their voices are heard during IPSDM. Buffering power differentials and increasing agreement about best options lead to well-informed decisions. A model was developed to illustrate the relationships among these concepts. Conclusions: Findings from this study improve understanding of how different members of the team participate in the IPSDM process, and highlight effective strategies to ensure professional voices are heard, understood and considered during deliberations.