title: Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.
abstract: OBJECTIVE
  To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital.
  
  
  METHODS
  An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis.
  
  
  RESULTS
  Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term.
  
  
  CONCLUSIONS
  Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.
authors.affiliation: University of Ottawa; Ottawa, Ontario; Children's Hospital of Eastern Ontario Research Institute; Ottawa, Ontario.
authors.forename: Laura
authors.initials: L
authors.lastname: Boland
authors.affiliation: The Ottawa Hospital Research Institute; Ottawa, Ontario.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: McIsaac
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute; Ottawa, Ontario; Children's Hospital of Eastern Ontario; Ottawa, Ontario.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Lawson
keywords: Barriers; Decision support; Facilitators; Implementation; Paediatric; Shared decision making