Table 2 Barriers to implementation of SDM and BCTs used to address them in the TTT training

Patients do not want to participate in making decisions

HCP & trainer

Patient involvement is not considered

Use of a credible source (9.1)

Evidence about patients’ preferences about taking control of their health choices and about HCPs’ flawed assumptions about what patients want are provided in Powerpoint presentation

Information about social and environmental consequences (5.3)

The training refers to national and regional policies and ethical guidelines supporting SDM

Providing prompts /cues (7.1)

Materials are shared: Patient activation brochure and poster, 6 steps to SDM “pocket reminder cards”

We are already doing SDM

HCP & trainer

Potential for improvement in patient involvement

Use of a credible source (9.1)

Evidence is provided on average level of patient involvement by HCPs

Instruction on how to perform the behaviour (4.1)

A structure for decision-making that involves patients is suggested using: 6 steps to SDM “pocket reminder cards” and example videos

Feedback on behaviour (2.2)

Feedback is provided to a model (HCP presented in a video example)

Demonstration of the behaviour (6.1)

The suggested consultation structure, 6 steps to SDM, is demonstrated using video examples

Social comparison (6.2)

HCP opinion-leaders are presented using video examples

Trainer feels insufficiently supported by management

Trainer

HCP – SDM trainings will not lead to behaviour change

Provision of/enabling social support (3.1–3)

Encouragement to make use of a permanent supervision offer to receive counselling communication on implementation of SDM at the hospital trusts

Information about social and environmental consequences (5.3)

The training refers to national and regional policies and ethical guidelines to implement SDM

SDM takes too much time

HCP & trainer

Patient involvement is not considered or essential elements are omitted

Use of a credible source (9.1)

Evidence is presented challenging the claim that SDM is too time consuming

Instruction on how to perform the behaviour (4.1)

Demonstration of the behaviour (6.1)

A structure for consultations involving patients is suggested using: 6 steps to SDM “pocket reminder cards” and example videos

Adding objects to the environment (12.5)

Trainees are introduced to Patient Decision Aids which have been developed to prepare patients for making health choices

An overarching implementation strategy is absent

Trainer

Ad hoc trainings might be carried out, but SDM is not implemented in a sustained fashion

Provision of/enabling social support (3.1–3)

Offer of assistance with implementation at their hospital trust

SDM is not relevant to us

HCP & trainer

Lack of awareness of preference sensitive decisions. HCPs might make decisions based on guidelines on behalf of the patients

Provision of/enabling social support (3.1–3)

During the training, the ambassadors are invited to a interprofessional network of SDM trainers and access to the “klarforsamvalg” webpage, hosting learning materials used in trainings is provided

Information about social and environmental consequences (5.3)

The training refers to national and regional policies and ethical guidelines supporting SDM

Information about health consequences (5.1)

Information is provided about effects of SDM on patient outcomes

Challenging to find the evidence for every medical problem

HCP & trainer

Decisions are not informed by best available evidence

Tailoring (Agbadjé 2020)*

Domain-specific decisions are identified using exercises

Criteria for evidence-based patient information are introduced

Adding objects to the environment (12.5)

Attention is called to Patient Decision Aids that are freely available on various health platforms

SDM is only about the doctors and their patients

HCP & trainer

Patient involvement might happen in isolated events (eg consultations), but is not implemented as a team culture

Tailoring (Agbadjé 2020) *

Problem solving (1.1)

Exercises and group discussion are used to draft solutions to interprofessional role distribution regarding typical domain-specific decision scenarios

Instruction on how to perform the behaviour (4.1)

Nurse-led decision coaching is presented using a sequence of PP slides as an example for interprofessional SDM

Information about social and environmental consequences (5.3)

Emphasis is given to virtues of interprofessional cooperation: confidence, respect, appreciation, sharing competences

Restructuring the social environment (12.2)

Advice to restructure information flow and interprofessional collaboration to promote patient involvement

Patients do not understand this information

HCP & trainer

HCP avoid providing evidence-based information

Use of a credible source (9.1)

Evidence is presented about patients’ ability to process evidence-based information

Instruction on how to perform the behaviour (4.1)

The criteria for evidence-based patient information are introduced and reference is made to the guideline evidence-based health information

Adding objects to the environment (12.5)

The trainers’ attention is called to tools and methods of risk communication

The trainer lacks opportunities to deliver the training

Trainer

SDM INTERPROF will not be implemented

Adding objects to the environment (12.5)

Trainers are equipped by materials for distribution and information to leaders

Guidance of action planning (1.4)

Opportunities are provided in structured exercises to make plans on by whom, where and when SDM trainings will be carried out

Ambassador does not feel sufficiently confident as a trainer

Trainer

SDM training is not effective or does not comply with Ready for SDM

Provision of/enabling social support (3.1–3)

A didactic model for planning the training is provided and assistance offered to conduct SDM trainings locally

Guidance of action planning (1.4)

Opportunities are provided in structured exercises to make plans about where and when SDM trainings will be carried out and by whom