Background As in most countries in Greece, medical consultations for RA are too short especially in public hospitals. Therefore there isn't enough time for doctors to educate patients about their disease, to discuss treatment options, to review the side effects and finally to adjust treatment strategies according to their patient's life and priorities.
Objectives After campaigning for change for so many years, we wanted answers to our main questions: a. Do doctors and patients view the importance of Shared Decision Making in the same way b. Is shared decision making possible within the current social, economic and cultural climate?
Methods Two full day mixed workshops were organized to discuss the realities of SDM in Greece today, to share ideas and explore solutions. One in Heraklion on 6/6/2015 involving 30 experienced patients and 6 Healthcare Professionals (4 rheumatologists, 1 GP, 1 nurse, 1 Anesthesiologist specializing in chronic pain).
The second workshop took place in Chania on 29/11/2015 involving 25 patients and 4 Healthcare Professionals (1 rheumatologist, 1 GP, 1 orthopedic, 1 nurse). After a short introduction the participants were divided into two groups: a doctors' group facilitated by a patient and a patients' group facilitated by a doctor. Both groups were asked to rate the degree of implementation of SDM in clinical practice, its usefulness for patients and to justify their ratings.
The patient Sub Group rated the usefulness of SDM 10 out of 10 but, the rate of its implementation was only 5 out of 10.They believe that SDM is more likely to occur after the 1st year of diagnosis and depends on: levels of mutual respect and doctor/patient trust, available time, patient preparation before the visit, level of education and information both patients and doctors have, and the weaknesses within the healthcare system.
The HCP Sub Group rated the usefulness of SDM 8–9 out of 10 but, the rate of its implementation was only 5 out of 10.The HCPs felt that the implementation of SDM depends on: the patients' age, educational level, willingness to participate and the doctors' attitude
Then the participants were split into three mixed groups and asked to explore the same topics such as: FEASIBILITY, BARRIERS, and SOLUTIONS and propose PRACTICAL STEPS
Results The implementation of SDM is very difficult under current conditions in the healthcare system. As main barriers were identified: lack of time, breakdown in the doctor/patient relationship, weakness in hospital systems & structures and lack of personal responsibility for decision making among some patients.To overcome these barriers a lot of interesting ideas were put forward such as: allow more time during the first consultation, prepare patients before their consultation for better use of time, recruit trained nursing staff who will be in more active contact with patients and the management of their disease, exploit new technologies for patient data transfer to doctors and vice versa, educate patients and doctors to appreciate the benefits of SDM.
Conclusions SDM allows the patient, to be an equal partner in their health care, working with their doctor, nurse or other health professional to make an informed decision about their treatment. However to be implemented in clinical practice doctors and patients need to be educated.
Disclosure of Interest E. Kritza Grant/research support from: Bristol-Myers Squibb Greece