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In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare. Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities. In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute's decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM., (Copyright © 2022. Published by Elsevier GmbH.)

Canada's approach to shared decision making (SDM) remains as disparate as its healthcare system; a conglomerate of 14 public plans - ten provincial, three territorial and one federal. The healthcare research funding environment has been largely positive for SDM because there was funding for knowledge translation research which also encompassed SDM. The funding climate currently places new emphasis on patient involvement in research and on patient empowerment in healthcare. SDM fields have expanded from primary care to elder care, paediatrics, emergency and critical care medicine, cardiology, nutrition, occupational therapy and workplace rehabilitation. Also, SDM has reached out to embrace other health-related decisions including about home care and social care and has been adapted to Aboriginal decision making needs. Canadian researchers have developed new interprofessional SDM models that are being used worldwide. Professional interest in SDM in Canada is not yet widespread, but there are provincial initiatives in Alberta, British Columbia, Ontario, Quebec and Saskatchewan. Decision aids are routinely used in some areas, for example for prostate cancer in Saskatchewan, and many others are available for online consultation. The Patient Decision Aids Research Group in Ottawa, Ontario maintains an international inventory of decision aids appraised with the International Patient Decision Aid Standards. The Canada Research Chair in SDM and Knowledge Translation in Quebec City maintains a website of SDM training programs available worldwide. These initiatives are positive, but the future of SDM in Canada depends on whether health policies, health professionals and the public culture fully embrace it., (Copyright © 2017. Published by Elsevier GmbH.)

Background: Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level., Methods: A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience., Results: Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers., Conclusions: Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

There is considerable interest for shared decision-making (SDM) within the Canadian healthcare system. The current state of SDM in Canada and challenges with implementation are addressed in the paper at three levels of patient involvement: (1) healthcare system (macro-level); (2) institutions (meso-level) and (3) clinical/medical encounter (micro-level). The legal obligation for doctors to fully disclose information enabling patients' participation in decisions has spawned professional codes and guidelines with a vision of patient's empowerment through the use of patient decision aid and SDM. Nevertheless, a survey of general practitioners in 2002 indicated that they perceived their role as relieving anxiety induced in patients rather than engaging them in informed decision-making. The virtue of SDM has gained recognition through increased research funding, medical training and some initiatives embedding patient decision aids within the process of care. Future perspectives of SDM in Canada are highlighted such as evaluation of the long-term impact of and costs associated with patient participation in decisions as well as interprofessional approaches to SDM.

A common thread weaving through the current public participation debate is the need for new approaches that emphasize two-way interaction between decision makers and the public as well as deliberation among participants. Increasingly complex decision making processes require a more informed citizenry that has weighed the evidence on the issue, discussed and debated potential decision options and arrived at a mutually agreed upon decision or at least one by which all parties can abide. We explore the recent fascination with deliberative methods for public involvement first by examining their origins within democratic theory, and then by focusing on the experiences with deliberative methods within the health sector. In doing so, we answer the following questions "What are deliberative methods and why have they become so popular? What are their potential contributions to the health sector?" We use this critical review of the literature as the basis for developing general principles that can be used to guide the design and evaluation of public involvement processes for the health-care sector in particular.

Health care systems are under pressure to control their increasing costs, to better adapt to evolving demands, to improve the quality and safety of care, and ultimately to ameliorate the health of their populations. This article looks at a battery of organizational options aimed at transforming health care systems and argues that more attention must be paid to reforming the delivery mechanisms that are so crucial for health care systems' overall performance. To support improvement, policies can rely on organizational assets in two ways. First, reforms can promote the creation of new organizational forms; second, they can employ organizational levers (e.g., capacity development, team- based organizations, evidence-informed practices) to achieve specific policy goals. In both cases organizational assets are mobilized with a view to creating complete health care organizations - that is to say, organizations that have the capacity to function as high- performing systems. The challenges confronting the development of more complete health care organizations are significant. Real health care system reforms may likewise require implementing ecologies of complex innovation at the clinical, organizational, and policy levels. Policies play a determining role in shaping these new spaces for action so that day-to-day practices may change. [ABSTRACT FROM AUTHOR]

Abstract: To resolve tensions among competing sources of evidence and public expectations, health-care managers and policy makers are turning more than ever to involve the public in a wide range of decisions. Yet efforts to use research evidence to inform public involvement decisions are hampered by an absence of rigorous public participation evaluation research. In particular, greater rigour in exploring the roles played by different contextual variables—such as characteristics of the issue of interest, the culture of the sponsoring organization and attributes of the decision being made—is needed. Using a comparative quasi-experimental design, we assessed the performance of a generic public participation method implemented in 5 Canadian regionalized health settings between 2001 and 2004. Participant and decision-maker perspectives were assessed and, through direct observation, the roles exerted by contextual variables over the public involvement processes were documented and analysed. Our findings demonstrate that a generic public participation method can be implemented in a variety of contexts and with considerable success. Context exerts fostering and inhibiting influences that contribute to more (or less) successful implementation. Public participation practitioners are encouraged to pay careful attention to the types of issues and decisions for which they are seeking public input. Sufficient organizational resources and commitment to the goals of the public participation process are also required. Attention to these contextual attributes and their influence on the design and outcomes of public participation processes is as important as choosing the “right” public participation mechanism. [Copyright &y& Elsevier]

Analyzes past experiences and future prospects of obtaining public input for health-systems decision-making in Quebec and Ontario. Structure and mandate of the regional health and social services boards and district health councils; Designing processes followed by the Quebec health authority decision-makers; Constraints faced by the authorities in mounting public consultation processes.

Gives a brief description of the process, the outcome, and the effects of the Romanow Commission on the Future of Health Care in Canada, which entailed a dialogue with representative cross-sections of the Canadian population. View that the legitimacy and sustainability of any major policy decisions depends on how well it reflects the underlying values of the public; Mention of ChoiceWork dialogues, which were created by Viewpoint Learning and based on the research of its chairman, Daniel Yankelovich; Way that the dialogues engage members of the public on important issues before the decisions are made; Impact of combining the roles of citizens as taxpayers and patients on the debate; Opinion that engaging the public in this way is more costly than polling, but is essential when making difficult decisions. INSETS: Summary points;Box 1: Basic steps in a ChoiceWork dialogue project;Box 2: Four scenarios for the future of health care in Canada;Box 3: Participants' own words (extracted from session...