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Table 4 Practical recommendations for further adoption of SDM in stroke care according to HCPs

From: Improvement of shared decision making in integrated stroke care: a before and after evaluation using a questionnaire survey

1. Start an awareness campaignPromotional material; SDM in strategic plans; articles on best practices and experiences with SDM (by well-known HCPs); reports on benefits; tools for self-reflection on SDM.
2. Appoint ambassadors in the organisationActivities to improve SDM in daily practice; involvement of staff and all HCPs.
3. Include SDM in training and courses of HCPsIn courses for HCPs. Topics: relational communication, neutral communication, decision-making dilemmas, teach-back. Include role play, personal reflection and peer observation.
4. Training on the jobE-learning courses and in-company training to practice and develop skills. Topics: relational communication, neutral communication, decision-making dilemmas, teach-back. Include role play, personal reflection and peer observation.
5. What matters to patients?Investigation of personal preferences before starting treatment discussions in multidisciplinary meeting; Personal decision tools to state preferences, documentation in electronic health record.
6. Involve relativesProper involvement of relatives because of cognitive and communication problems that can occur. Explanations of roles and responsibilities.
7. Implementation via stroke services and care  chainsIn meetings of regional and organisational team: discuss how to embed SDM in existing care chains. Agreements on roles and responsibilities for specific decision points for example “transfer charts”.
8. Provide an overview of the available primary  care for strokes in the regionAn informative overview of primary HCPs and organisations who have expertise in stroke care to assist SDM on transfer to primary care. Develop/include quality indicators for primary care in terms of volume norms and requisite training