Implementation of a shared decision making process for severe stroke-a mixed methods study

Abstract

Purpose Clinical decisions made early after stroke can make the difference between survival with disability or death. We aimed to develop, implement and evaluate a new Shared decision making (SDM) process for severe stroke into a regional 36 bedded stroke unit. Methods We developed the process through four coproduction workshops, attempted its implementation then evaluated its impact on death, discharge to institutional care (care home or NHS continuing care) and tube feeding at 6 months. We also explored patients,’ families’ and staff views about SDM. Results Eleven people (staff and people with lived experience of stroke) attended the first co-production workshop, eight the second, seven the third and six the fourth. The new SDM process incorporated Tailored Talks (a digital platform with information about stroke) and an implementation plan.We implemented this process on 1^st August 2022. Only eight out of 1020 patients received Tailored Talks (four before and four after implementation). For the entire group there was no change in tube feeding, discharge to institutional care or death. The proportion of people with severe strokes dead at six months was lower after implementation (p=0.04), though the significance of this is uncertain. Staff interviews suggested that insufficient time, lack of a ‘human touch’ and inadequate leadership explained the lack of implementation. Conclusion Our co-produced SDM process was not effectively implemented into a stroke unit and there was no impact on the use of tube feeding, discharge to institutional care or death at six months.