Lessons learned from the development and implementation of a shared decision making process for severe stroke using a digital communication platform

Clinical decisions made immediately post-stroke can determine survival outcomes and disability. This study aimed to develop, implement, and evaluate a shared decision-making (SDM) process for severe stroke that incorporates a digital communication platform (Tailored Talks) within a 36-bed stroke unit. Using a coproduction approach, we introduced Tailored Talks to facilitate information sharing and assessed its impact on 6-month mortality, discharge to institutional care, and tube-feeding. Additionally, we explored perspectives of patients, families, and staff regarding SDM. Of 1020 patient with stroke, eight received Tailored Talks (4 before and 4 after implementation), with no observed changes in clinical outcomes. Staff interviews identified insufficient time, lack of a personal touch, and inadequate leadership as barriers to implementation. Workforce shortages and technological limitations hindered the integration of SDM into routine stroke care. Addressing these challenges is crucial to enhancing SDM for patients with severe stroke.