Table 4.

Illustrative Quotes From Working Session Breakout Group Discussions

Group 1: Designing a guide for implementation of SDM in clinical settings
Key components of adaptation guides	“Way to identify eligible population. Core and optional components of SDM. Ways to track and monitor progress. Roles-definition and process tools. Itemize and document.”
SDM adaptations and customizations	“Using the interchangeable parts theory, creating a framework with primary stakeholder (end users), with interchangeable details within model. Each discipline may have differing specifics, but the process framework seems universal.”
SDM implementation progress tracking	“Incorporate into workflow. Engage and train staff. Engage stakeholders and build consensus about timing and tracking procedures. Account for patient preferences.”
Needed research for toolkit development and application	“Need to isolate/test the most parsimonious set of strategies to support SDM delivery with fidelity.”
Group 2: Disseminate educational curricula on SDM
Strategies to ensure wide adoption of SDM curricula among medical, nursing, and allied health professional schools	“Work with student organizations like American Medical Student Association to create the ground swell for culture of SDM.”
Strategies to ensure wide adoption of SDM curricula among residency/fellowship programs	“Need for role models and direct observation. Build into competency for graduating or completing course/rotation.”
Strategies to ensure wide adoption of SDM curricula for continuing education among practicing health professionals	“Provide CE across multiple disciplines to support team based implementation.”
Other strategies	“By the way we need to train the public in this starting in grade school! Every patient should have a clear sense of the question ‘What’s important to you?’ before each visit. This must be taught.”
Group 3: Influencing policies to increase SDM use
Targets for policy interventions	“Focus on CMS. Their decision to pay for SDM is huge. We should push them to incentivize SDM for more treatment decisions, and help them by advocating for a certifying body to ensure SDM is done well.”
Strategies to engage these groups	“Know your context (ecosystem)-where is the perceived need greatest? Know your competition-competing messaging and behaviors. Focus the message on providing a solution for ‘jobs to be done’ of your target audience adopter, for example, meeting accreditation, saving money, meeting patient demand or satisfaction”
Essential questions to answer to influence policy	“Do a case study of Washington State to examine how policy levers, health systems, patient voice, regulation/certification, and payment approaches combined to create a favorable landscape for SDM.”

CE, continuing education; CMS, Centers for Medicare and Medicaid Services; SDM, shared decision making.