Placement: The Dartmouth Institute for Health Policy and Clinical Practice
Mentor: Glyn Elwyn M.D., Ph.D., F.R.C.G.P. (Professor and Senior Scientist, The Dartmouth Institute for Health Policy & Clinical Practice)
Co-Mentor: Sarah Kobrin, Ph.D., M.P.H. (Acting Branch Chief, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute)
Project Title: Enhancing the Implementation of Shared Decision-making in Cancer Care through Solutions that Address Organizational-level Barriers
Isabelle Scholl, Ph.D., is a 2016-17 German Harkness/B. Braun Stiftung Fellow in Health Care Policy and Practice. She is currently head of the research group “Patient-Centered Care: Evaluation and Implementation” within the Department of Medical Psychology at the University Medical Center Hamburg-Eppendorf. In this role, she focuses on measuring and implementing shared decision-making and patient-centered care. As part of her Ph.D. thesis, she developed and psychometrically tested the “9-item Shared Decision Making Questionnaire,” which has been translated into thirteen languages and used in both studies and quality improvement initiatives worldwide. Scholl has held a number of prestigious fellowships, including the Academy for Early Career Researchers in Health Services Research, a fellowship which she held in 2010, awarded by the German Research Foundation for early career researchers. Within the European Association for Communication in Healthcare, she is also the co-founder of the Young European Association for Communication in Healthcare committee, which aims to stimulate networking and collaboration, and deliver mentorship to early career professionals. Scholl received her doctorate from the University of Hamburg, has a degree in psychology from the University of Freiburg, and is a licensed psychotherapist.
Project Abstract:
Shared decision-making is especially relevant in oncology, where multiple treatments are viable and choices are preference-sensitive. Despite the push for shared decision-making on the health policy level, its implementation into practice remains a challenge, and Implementation efforts have been limited to the individual patient-clinician level. However, organizational-level barriers to the implementation of shared decision-making have recently been described, and the current structure of multidisciplinary team meetings was identified as a particular barrier to shared decision-making in cancer care. This study aims to first compile an overview of organizational-level barriers to the implementation of shared decision-making in cancer care and solutions to overcome these barriers, particularly in regards to the organization of multidisciplinary team meetings, and second, to identify and explore “hot spots” of pioneering best practice solutions to address the identified factors.
In Phase one, a scoping review will be conducted to identify organizational-level barriers and solutions to address these barriers. In phase two, semi-structured interviews will be conducted with key stakeholders to validate the results of phase one and identify cancer care organizations known for innovative solutions that tackle organizational-level barriers to shared decision-making. Two organizations will be selected. Phase three will consist of participant observation to further investigate best practice examples. The overarching goal is to identify opportunities for fostering the implementation of shared-decision making in routine cancer care, and to derive recommendations for policy makers and health care institutions.