eRapport

DA factory

Prosjekt
Prosjektnummer
HST1246-15
Ansvarlig person
Jürgen Kasper
Institusjon
Universitetssykehuset Nord-Norge
Prosjektkategori
Inkubatorstøtte (ph.d.-stipend)
Helsekategori
Generic Health Relevance
Forskningsaktivitet
8. Health Services
Rapporter
2018
Til tross for limiterte resurser 2018 (mammapermisjon og mangel av ansettelsesforhold til prosjektledelsen) viser prosjektet fremskritt, spesielt mht. utvikling og evaluering av "klar for samvalg". DAfactory driver også implementering: MAPPIN SDM observatørkurs, gruppe og enkelt opplæring i samvalg, train the trainer. Intenst arbeid med nettverk.Aktvitetene og utbytte av prosjektet i 2018 er limitert grunnen mammapersmisjon og mangel pü ansettelsesforhold til prosjektledelsen Å styrke metodene som redskap for evalueringsstudier innen samvalg i Norge er ett av prosjektets mål. Etter MAPPIN SDM har blitt validert som måleinstrument for samvalg i Norsk språk i studier som ble gjennomført i de forrige årene gelder aktivitetene nå spredning av kompetansen å håndtere instrumentet. Det ble gjennomført MAPPIN SDM intensiv kurs med 6 nøkkelpersoner fra hele landet. Hensikten med kurset var også å styrke en felles faglig forståelse av samvalg som grunnlag for videre samarbeid om implementering av samvalg i Norge. Kurset lyktes med å oppnå kursmålet som var et predefinert nivå på samsvar som gjenspeiler observatør kompetansen til kursdeltakerne. Opplæring innen klar for samvalg (K4S): Prosjektets hensikt er også å utvikle, evaluere og implementere oppærings tiltak innen samvalg. I løpet av de siste årene, ble K4S utkastet og det ble igangsatt evalueringsprogrammet. I 2019 har DAfactory gruppen i samarbeid med Helse Vest og Helse Sør Øst brukt K4S i flere kliniske kontekster. Helse Sør Øst har utviklet en implementeringsplan for samvalg, hvor K4S er sentral sammen med samvalgs verktøyene som ble utviklet i HN og HSØ. I tillegg ble implementering igangsatt i psykiatrien i Helse Bergen i sammenheng med prosjektet «Ikke medikamentell behandling av psykose». K4S (tverrfaglig modul / gruppe) ble gjennomført mer enn 20 ganger i .l.a. 2019. Som en annen modul ble «doktormitSDM» pilotert for første gang i Norge. doktormitSDM er en vel dokumentert opplæringsmetode som innebærer en-to-en feedback for helsepersonell på egne opptak av kliniske samtaler basert på AMPPIN SDM analyser. I Stavanger ble det opplært en hel psykiatrisk avdeling med både K4S (tverrfaglig modul /gruppe) og «doktormitSDM». Videre har gruppen i samarbeid med HSØ avdelingen for samhandling utviklet og gjennomført en train the trainer opplæringsprogramm. Som del av HSØ sin implementeringsstrategi er det målsettingen å kvalifisere nøkkel helsepersonell og sette de istand for de kan selv gjennomføre kurset. Hittil ble det utdannet 40 helsepersonell. Nye kurs er planlagt for 2019. I tillegg skal det iverksettes et elæringsprogramm. Som del av PhD løpet skal e-læringsprogrammet som JK har evaluert i Tyskland overføres til den norske konteksten. Utvikling av tiltaket krever tilleggsfinansiering som ikke ligger i prosjektets budsjett. HSØ fører en sak om en felles utvikling i alle helseforetakene i samarbeid med et mediebedrift som skal faglig ledes av JK og SK. Som del av evalueringen i Simone Kienlins program for sitt PHD løp ble det gjennomført en multisenter cluster-randomisert studie der vi har undersøkt effektene av selve «klar for samvalg» opplæringen. Data innsamlingen ble avsluttet før sommeren. Analysen blir gjennomført tidlig i 2019 og presentert ved den internasjonale samvalgs konferansen i Quebec. Nettverksarbeid var utmerket og internasjonalt: Helse Bergen distriktspsykiatriske tjeneste, Zurich Universitetssykehus, OCHER er Oslo Communication in Healthcare Research group, Veilederprosjektet i Helse Stavanger, HSØ avdeling samhandling, Innovasjonsfonds i Tyskland med 14 million Euro DAfactory som forsknings og utviklingsprosjekt forsetter 2019 med justert logistikk og kontekst siden UNN som host (vert) til prosjektet desverre ikke lenger er tilgjengelig som før.

Brukermedvirkning er sentralt tema i prosjektet. Ingenting i prosjektet skjer uten å prioritere brukermedvirkning. Prosjektet skal fremme den mest rigorøse og konsekvente måten på brukermedvirkning, samvalg, hvor brukeren blir støttet i å ta informerte valg om egen helse: samvalg er primær utfallparameter i alle våre evalueringstudier. Brukerne i vår sammenheng er helsepersonell og pasienter. I det siste året ble brukerne involvert i evaluering av "klar for samvalg" opplæringsmodulen gejnnom spørreskjema, fokusgruppe, deltakelse, tilbakemeldinger. Økning av brukermedvirkning i sin rigorøs forståelse er målsetting av prosjektet. Det ble også utviklet og gjennomført en train the trainer program som gir mulighet for bruk klar for samvalg av mange helsepersonel i Norge. Slik søger vi for at helsepersonell i hle landet er delaktig vår kunnskap.

2017
The DAfactory is now condensed as didactically refined and detailed guide on DAfactory.no, soon to be published. The German Innovationsfonds allocated 14 Million € to using DAfactory for full scale implementation of SDM in a German hospital. Klarforsamvalg has been further completed by evaluating training modules. The candidate has 23 months left.organizational matters During 2017, Mine behandlingsvalg and DAfactory became even more interrelated sharing plans and resources. MB received more funding from HN. Although meant to strengthen the staff, this was not done due to lacking permission by our administrative leader. The mandate of the MD/DAfactory group was expanded by a newly arriving order from HOD giving HN responsibility for leading a national implementation of SDM. The fellow continued part time as in 2016 and is a very productive and stable factor in the project. She has now spent 13 of 36 stipend months. Main activities and achievements The generic procedure to develop and implement SDM was further refined and condensed as a web-based interactive guide. The curriculum presents in Norwegian and English language and has been piloted twice. DAfactory.no is about to be published. This work was guided by experiences during development of the next generation of decision aids in Mine Behandlingsvalg (knee arthrosis, hip arthrosis, submucosal myomas, Grave’s disease, breast cancer, metastasised prostate cancer). In particular, many methods belonging to the DAfactory were by manualization standardized. E.g. • adjustment of the didactic approach to the respective target group using a 4 steps procedure • Instruction film team • Prioritization of medical problems for DA developments Following the original plan, MB should be developed by RCT. The protocol was written in cooperation with NSE. The plan to employ a study coordinator to conduct the cluster-RCT failed by undecidedness of administrative leader. The study is pending. The comprehensive and adaptive SDM training inventory Klarforsamvalg was further completed: • Webbased SDM teaching: 5 of 7 shortfilms published • SDM group teaching 60 minutes: ready developed and evaluated • Train the trainer SDM group teaching 60 minutes: ready developed • SDM group training 120 minutes (interactive, video-based). Evaluated feasible and effective • doktormitSDM 1:1 analogue training: effective, feasible • e-turial LIS: conceived not yet produced. Decision on funding pending. • Student curriculum: components readily tested • Train the mentors (Profkom): conceived, first conduct spring We put a lot of emphasis on strengthening our network and making the DAfactory part of the communication in the scientific community: Therefore, we counselled associated research applications and projects in all four health regions. SK spent a month abroad at the Ottawa Health Research Institute with Prof. Dawn Stacey, France Légaré and others, establishing sustainable cooperation. JK received a chair in the scientific board of the German foundation of health knowledge (SGW) in Berlin. We visited meeting (ISDM Lyon, DNEBM Hamburg and national conferences). The German Innovationsfonds allocated 14 Million € on using DAfactory for full scale implementation. JK spent a lot of time and many meeting to prepare the start of the project in October 2018. He is responsible for all five interventions provided in combination at one large hospital, additionally, for translation of the knowledge to the German context. https://innovationsfonds.g-ba.de/projekte/neue-versorgungsformen/making-sdm-a-reality-vollimplementierung-von-shared-decision-making-im-krankenhaus.96. The project has broad international attention. Due to administrative challenges, however, it started in October without the Norwegian originators and none of the project workers was allowed to be employed at UNN.
2016
DAfactory and Mine Behandlingvalg received further funding to intensify production of decision support and facilitate rollout of the project's achievements nationwide. A virtual production site of decision aids was established among others providing implementation strategy and a curriculum for health professional training in shared decision making.organizational matters Within 2016 activities in development, testing and publishing decision support strategies were intensified. In march the PhD fellow Simone Kienlin joint the group and is working on 50% with her program since. The two projects DAfactory and Mine Behandlingsvalg merged completely and received additional funding (4.5 million NOK for 2016) from Helse Nord allowing for employing stuff contributing to production of more decision aids and rollout of newly developed means nationwide. achievements 2016 Together with the research fellow we published our results on the validation of the Norwegian version of the MAPPIN’SDM outcome measure. As many requests and discussions indicate, this work is appreciated by a couple of Norwegian research groups in need for this type of outcome parameter. Main emphasis was given to refinement of the DAfactory, which has become a virtual production site of patient decision support aiming at implementing patient involvement into health care. Production in the DAfactory is following a framework of standard strategies, guidelines and particular manuals organized in a system of nine components. Since DAfactory is highly structured and most procedures now present as detailed manuals, it can be used by inter-professional teams including nonscientific personnel. This applies after intensive training following the DAfactory curriculum. The DAfactory is a complex intervention One of the five decision aids (DA), published in 12 2015 was by a cooperation project with Kreftforening Helsedirektoratet and E–Helsedirektoratet adjusted and moved to the national health platform Helsenorge.no. This process led to further sharpening of the methods and included another evaluation study with health professional and patient users. As a conclusion from this project, Helsedirektoratet commissioned more decision aids for Helsenorge. The merged project group counselled Helsedirektoratet in a project seeking national consensus about (DA) quality criteria. We also delivered an implementation plan for shared decision making to Helsedirektoratet, applying the DAfactory concept to the whole country. As an essential part of this, a comprehensive meta-curriculum for health professional training in SDM has been developed (klar for samvalg). The curriculum is generic with regard to didactic methods and adjustable with regard to health profession, previous knowledge and setting. Continuing previous research with components of the current curriculum three different applications have already been realized and tested with user groups. A e-learning program addressing physicians in specialist medical training (LIS) is on the way and will be used on national level. A cooperation with the NSE the institute for E-health research in Tromsø has been established to conduct the randomized controlled trial, within which according to DAfactory protocol the combination of decision aid and health professional training shall pass efficacy testing. This is about to happen 2018. In addition, we were involved in counselling a couple of associated research applications and projects in all four health regions, thereby establishing sustainable research network. This applies also internationally, particularly with OHRI, the Ottawa Health Research Institute, the German Institute for Quality and Efficiency in Health Care (IQWiG) and the German foundation of health knowledge (SGW) in Berlin. Thank you for the trust you have placed in us!!
2015
As DAfactory aims at contributing to ongoing DA development in the Helse Nord project “Mine behandlingsvalg” (MB), providing knowledge on development of complex interventions in the field of evidence based patient counselling, the project agenda 2015 was tightly interweaved with MB. This cooperation implied mutual use of resources.RESEARCH ACHIEVEMENTS OF DAfactory 2015 (full version at k@sper.info) VALIDATION OF MEASURES OF PATIENT INVOLVEMENT MAPPIN’SDM (the Multifocal APProach to the sharing IN Shared Decision Making) was developed 2011 in Germany as a multi perspective measure of shared decision making has been professionally translated, linguistically edited and validated in two studies. DEVELOPMENT OF FIVE DECISION AIDS AS PART OF MineBehandlingsvalg DAfactory contributed to the development of five treatment decision aids (DA) supposed to be included in the web based platform Mine behandlingsvalg at UNN. This contribution referred to all development steps and all components of the decision aids (which addressed the decisions about treatment of pancreas cyste /cancer, prostate cancer low risk /high risk and adipositas). In particular DAfactory provided the following: • Drafting Concepti: decision aid at the UNN • Theory based needs analyses • Translation of needs into a didactic strategy • Search and extraction of medical contents • Selecting and presenting contents according to EBPI criteria • Developing value deliberation tools • Study protocol piloting strategy of the preliminary versions DEVELOPMENT OF A DA DEVELOPMENT TEMPLATE = DAfactory DAfactory provides: • Theory based needs analysis • Participation of clinical teams in the development • Systematic search and collection of medical contents • Theory based didactic concept • Component structure and internal structure and web-design accordingly • Frequency format for presentation of numerous data • Evaluation design DEVELOPED IMPLEMENTATION STRATREGY PUBLICATION ACTIVITY (in detail elsewhere) 5 papers submitted, 4 published 8 papers in preparation 5 contributions to international conferences 6 presentations at Norwegian conferences FUNDING ACQUIRED • Helse Nord: health research call 2015: 3 years postdoc program • Helse Nord : to achieve SDM full implementation in UNN hospital and beyond. The budget for the next three years (2016-18) is about 9 Million NOK per year( for details see attached document “Samvalg I Helse Nord”). RESEARCH GROUP AND NETWORK As DAfactory was funded as one of two projects in the category “inkubatorstøtte”, the project is committed to the announced goal to establish a research network on evidence based health communication. Although not yet formally approved, a broad and lively network is growing both nationally and internationally. OUTLOOK Understanding of the way and extent, structural change of clinical practice is dependent on science based knowledge will bridge the gap between clinical sided (UNN) and University (UiT) sided measures. 2016 DAfactory will • develop a robust collaboration structure that supports the further work of DA and MB according to adopted application “Samvalg i Helse Nord” • continue testing MB • agree with UNN HF upon a set of criteria used to identify predestined medical domains for new DA • contribute to adjusting MB as the national decision aid pilot at helsenorge.no • contribute to the production of new DA • start dialogue for integration of shared decision making in the curriculum for health professionals • publish gained research results in peer reviewed journals • intensify development of implementation strategy at UNN and other collaborating hospitals and organizations • formally apply for research group at UiT Electronical short report is published at http://forskningsprosjekter.ihelse.net.
Vitenskapelige artikler
Geessink NH, Ofstad EH, Olde Rikkert MGM, van Goor H, Kasper J, Schoon Y

Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients' and observers' perceptions.

Patient Educ Couns 2018 10;101(10):1767-1774. Epub 2018 jun 13

PMID: 29933924

Gaissmaier W, Giese H, Galesic M, Garcia-Retamero R, Kasper J, Kleiter I, Meuth SG, Köpke S, Heesen C

Numeracy of multiple sclerosis patients: A comparison of patients from the PERCEPT study to a German probabilistic sample.

Patient Educ Couns 2018 Jan;101(1):74-78. Epub 2017 jul 17

PMID: 28764895

Kasper J, Lager AR, Rumpsfeld M, Kienlin S, Smestad KH, Bråthen T, Ankell H, Knutsen T, Kløvtveit R, Gulbrandsen P, Vandvik PO, Heen AF, Flottorp S, Tollåli G, Eiring Ø

Status report from Norway: Implementation of patient involvement in Norwegian health care.

Z Evid Fortbild Qual Gesundhwes 2017 Jun;123-124():75-80. Epub 2017 mai 22

PMID: 28546052

Kasper J, Liethmann K, Heesen C, Reissmann DR, Geiger F

Training doctors briefly and in situ to involve their patients in making medical decisions-Preliminary testing of a newly developed module.

Health Expect 2017 Dec;20(6):1254-1263. Epub 2017 mai 18

PMID: 28521082

Kienlin S, Kristiansen M, Ofstad E, Liethmann K, Geiger F, Joranger P, Tveiten S, Kasper J

Validation of the Norwegian version of MAPPIN'SDM, an observation-based instrument to measure shared decision-making in clinical encounters.

Patient Educ Couns 2017 Mar;100(3):534-541. Epub 2016 okt 26

PMID: 28029570

Eiring Ø, Nytrøen K, Kienlin S, Khodambashi S, Nylenna M

The development and feasibility of a personal health-optimization system for people with bipolar disorder.

BMC Med Inform Decis Mak 2017 Jul 10;17(1):102. Epub 2017 jul 10

PMID: 28693482

Rahn AC, Köpke S, Backhus I, Kasper J, Anger K, Untiedt B, Alegiani A, Kleiter I, Mühlhauser I, Heesen C

Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) - Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation.

Int J Nurs Stud 2017 Aug 26. Epub 2017 aug 26

PMID: 28982479

Köpke S, Kasper J, Flachenecker P, Meißner H, Brandt A, Hauptmann B, Bender G, Backhus I, Rahn AC, Pöttgen J, Vettorazzi E, Heesen C

Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study.

Clin Rehabil 2017 Feb;31(2):250-261. Epub 2016 jul 10

PMID: 27072153

Kasper J, van de Roemer A, Pöttgen J, Rahn A, Backhus I, Bay Y, Köpke S, Heesen C

A new graphical format to communicate treatment effects to patients-A web-based randomized controlled trial.

Health Expect 2016 Dec 16. Epub 2016 des 16

PMID: 27981688

Riechel C, Alegiani AC, Köpke S, Kasper J, Rosenkranz M, Thomalla G, Heesen C

Subjective and objective knowledge and decisional role preferences in cerebrovascular patients compared to controls.

Patient Prefer Adherence 2016;10():1453-60. Epub 2016 aug 2

PMID: 27536077

Albrecht M, Isenbeck F, Kasper J, Mühlhauser I, Steckelberg A

The Foundation in Evidence of Medical and Dental Telephone Consultations.

Dtsch Arztebl Int 2016 Jun 06;113(22-23):389-95.

PMID: 27374375

Geiger F, Clayman ML, Scholl I, Liethmann K, Kasper J

Mapping search terms to review goals is essential.

BMJ Qual Saf 2016 Feb;25(2):130. Epub 2015 nov 30

PMID: 26621914

Buhse S, Mühlhauser I, Heller T, Kuniss N, Müller UA, Kasper J, Lehmann T, Lenz M

Informed shared decision-making programme on the prevention of myocardial infarction in type 2 diabetes: a randomised controlled trial.

BMJ Open 2015;5(11):e009116. Epub 2015 nov 13

PMID: 26567256

Heesen C, Kasper J, Fischer K, Köpke S, Rahn A, Backhus I, Poettgen J, Vahter L, Drulovic J, Van Nunen A, Beckmann Y, Liethmann K, Giordano A, Fulcher G, Solari A,

Risk Knowledge in Relapsing Multiple Sclerosis (RIKNO 1.0)--Development of an Outcome Instrument for Educational Interventions.

PLoS One 2015;10(10):e0138364. Epub 2015 okt 2

PMID: 26430887

Rahn AC, Köpke S, Kasper J, Vettorazzi E, Mühlhauser I, Heesen C

Evaluator-blinded trial evaluating nurse-led immunotherapy DEcision Coaching In persons with relapsing-remitting Multiple Sclerosis (DECIMS) and accompanying process evaluation: study protocol for a cluster randomised controlled trial.

Trials 2015;16():106. Epub 2015 mar 21

PMID: 25872529

Reissmann D, Bellows J, Kasper J

Patient preferred and perceived control in dental care decision-making

JDR Journal of dentistry research

Köpke S, Kasper J, Flachenecker P, Meissner H, Brandt A, Hauptmann B, Bender G, Backhus I, Rahn A, Poettgen J, Vettorazzi E, Heesen C

Patient education programme on disease modifying therapy in multiple sclerosis (PEPIMS) – a controlled rater-blinded study

Clin Rehabil. 2016 Apr 12,Epub ahead of print

Kasper J, Rahn AC, Kienlin S, Eiring Ø, Heesen C

Samvalgsveiledning gitt av sykepleiere for å involvere pasienter med multippel sklerose i beslutninger om immunterapi.

BestPractice Psykiatri / Nevrologi Sept. 2016; 14-17.

Kasper J, van de Roemer A, Pöttgen J, Backhus I, Bay Y, Köpke S, Heesen C

Clarifying risk figures using a new presentation format – a web-based randomized controlled trial

submitted to HEX

Deltagere
  • Espen Andreas Brembo Prosjektdeltaker
  • Kari Nytrøen Prosjektdeltaker
  • Simone Maria Kienlin Doktorgradsstipendiat
  • Jürgen Kasper Prosjektleder
  • Eirik Hugaas Ofstad Postdoktorstipendiat
  • Simone Kienlin Prosjektdeltaker
  • Anne Regine Lager Prosjektdeltaker
  • Markus Rumpsfeld Prosjektdeltaker
  • Jürgen Kasper Prosjektleder

eRapport er utarbeidet av Sølvi Lerfald og Reidar Thorstensen, Regionalt kompetansesenter for klinisk forskning, Helse Vest RHF, og videreutvikles av de fire RHF-ene i fellesskap, med støtte fra Helse Vest IKT

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