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Stiefel F, Bourquin C, Salmon P, Achtari Jeanneret L, Dauchy S, Ernstmann N, Grassi L, Libert Y, Vitinius F, Santini D, Ripamonti CI. Communication and support of patients and caregivers in chronic cancer care: ESMO Clinical Practice Guideline. ESMO Open 2024; 9:103496. [PMID: 39089769 PMCID: PMC11360426 DOI: 10.1016/j.esmoop.2024.103496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 08/04/2024] Open
Abstract
•ESMO Clinical Practice Guideline with key recommendations for communication and support of cancer patients and caregivers. •The guideline discusses training in communication of oncology clinicians and research on communication in cancer care. •Practical recommendations aim to support oncology clinicians in their communication with patients and caregivers. •Figures summarising the responsibilities of the clinician, the oncology team and the health care institution are provided.
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Affiliation(s)
- F Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P Salmon
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - L Achtari Jeanneret
- Department of Oncology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - S Dauchy
- Département Médico-Universitaire Psychiatrie et Addictologie, AP-HP, Centre-Université de Paris, Paris; Centre National Fin de Vie-Soins Palliatifs, Paris, France
| | - N Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn; Chair of Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Y Libert
- Université libre de Bruxelles (ULB), Faculté des Sciences Psychologiques et de l'Éducation, Brussels; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Service de Psychologie (Secteur Psycho-Oncologie), Brussels, Belgium
| | - F Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital and University of Cologne, Cologne; Department of Psychosomatic Medicine, Robert-Bosch Hospital Stuttgart, Stuttgart, Germany
| | - D Santini
- Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome
| | - C I Ripamonti
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy
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Yang H, Chen S, Zhao N, Zhou X, Cui L, Xia W, Li Y, Zhu H. Effects of online continuing medical education on perspectives of shared decision-making among Chinese endocrinologists. BMC MEDICAL EDUCATION 2023; 23:878. [PMID: 37978373 PMCID: PMC10657027 DOI: 10.1186/s12909-023-04838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Shared decision-making (SDM) may influence the clinical outcomes of patients with endocrine disorders. There are few studies describing perspectives towards SDM among endocrinologists in China. METHODS In the first stage, we conducted a national survey using an online questionnaire about SDM among endocrinologists in China. The national survey focused on attitude and propensity, potential barriers, and the effectiveness of SDM implementation strategies. In the second stage, survey participants were further recruited to participate in a prospective cohort study in the online continuing medical education (CME) program of Peking Union Medical College Hospital in Beijing. The Shared Decision-Making Questionnaire (SDM-Q-Doc) was employed to assess the effects of online CME on physicians' perspectives during the process of SDM, which was conducted before and after the CME course was provided. RESULTS In the national survey, 280 endocrinologists (75.7% female, mean age 38.0 ± 4.5 years, 62.5% with a duration of practice of more than ten years) completed the questionnaire. Participants had a generally positive attitude towards SDM in clinical practice. The main perceived barriers included time consumption, information inequality between doctors and patients, and a lack of technical support and training for SDM. The main uncertainties of implementation steps included inviting patients to participate in SDM (16.3%), assisting in decision-making (15.3%), facilitating deliberation and decision-making (13.7%), and providing information on benefits and risks (12.6%). Of the physicians who participated in the national survey, 84 registered for the eight-day online CME course. The SDM-Q-Doc score increased from 87.3 ± 18.2 at baseline to 93.0 ± 9.3 at the end of the 8-day online CME training (p = 0.003, paired t test). The participants' age, sex, education level, practice duration, the annual number of patients with rare endocrine diseases, and the annual number of patients requiring MDT or CME were not significantly related to increased SDM-Q-Doc scores after online CME (all p > 0.05). CONCLUSIONS Chinese endocrinologists had a generally positive attitude towards SDM in clinical practice. There were also several uncertainties in the implementation steps of SDM. Regardless of a physician's educational background or prior professional experience, CME may help to improve their perspectives regarding SDM.
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Affiliation(s)
- Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Shi Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Nan Zhao
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Zhou
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Lijia Cui
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Weibo Xia
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Yuxiu Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China.
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Porta-Etessam J, Santos-Lasaosa S, Rodríguez-Vico J, Núñez M, Ciudad A, Díaz-Cerezo S, Comellas M, Pérez-Sádaba FJ, Lizán L, Guerrero-Peral AL. Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine. Neurol Ther 2023; 12:1319-1334. [PMID: 37310593 PMCID: PMC10310651 DOI: 10.1007/s40120-023-00495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. METHODS A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). RESULTS A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3 years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. CONCLUSION SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.
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Affiliation(s)
- J Porta-Etessam
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - S Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | | | | | | | - L Lizán
- Outcomes'10, Castellón, Spain.
- Department of Medicine, Jaume I University, Av. Sos Baynat s/n, 12071, Castellón, Spain.
| | - A L Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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Diouf NT, Musabyimana A, Blanchette V, Lépine J, Guay-Bélanger S, Tremblay MC, Dogba MJ, Légaré F. Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review. JMIR MEDICAL EDUCATION 2022; 8:e42033. [PMID: 36318726 PMCID: PMC9773026 DOI: 10.2196/42033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. OBJECTIVE In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. METHODS From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. RESULTS Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. CONCLUSIONS Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.
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Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Angèle Musabyimana
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetic and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Johanie Lépine
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie-Claude Tremblay
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Maman Joyce Dogba
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Scherr S, Reifegerste D, Arendt F, van Weert JCM, Alden DL. Family involvement in medical decision making in Europe and the United States: A replication and extension in five Countries. Soc Sci Med 2022; 301:114932. [PMID: 35378430 DOI: 10.1016/j.socscimed.2022.114932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/04/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2018, Alden et al. showed that the desired degree of family involvement in medical decisions is an individual preference that is largely independent from East-West cultural stereotypes. At the same time, individual-level interdependence influenced whether patients preferred more individual or more family involvement in their decision making together with their medical care provider. The present study provides empirical evidence and adds evidence for Europe for which no such data previously existed. METHODS The present study is a direct replication and extension of the original Alden et al. (2018) study (N = 2031; Australia, China, Malaysia, India, South Korea, Thailand, United States [U.S.]), however, using survey data from four European countries (Austria, Belgium, Germany, Netherlands) and the United States (U.S.) with a total sample size of N = 2750. RESULTS Random effects within-between models replicated the original primary finding that those with higher self-involvement in medical decision making preferred less family involvement. Furthermore, patients with lower self-independence, higher relational interdependence, and stronger beliefs in social hierarchy are more likely to want their families involved in medical decisions besides their health care provider. CONCLUSIONS These observed relationships are largely consistent both within and across the four European countries and the U.S. In conclusion, the results point to the importance of avoiding cultural stereotypes and instead, recognizing that patient desires for family involvement in medical decision making vary dramatically within cultures depending on multiple individual differences. Furthermore, a growing body of evidence suggests that these antecedents of family involvement as well as the construct itself may be measurable in diverse cultures with high levels of confidence in their reliability and validity.
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Are shared decision making studies well enough described to be replicated? Secondary analysis of a Cochrane systematic review. PLoS One 2022; 17:e0265401. [PMID: 35294494 PMCID: PMC8926249 DOI: 10.1371/journal.pone.0265401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background Interventions to change health professionals’ behaviour are often difficult to replicate. Incomplete reporting is a key reason and a source of waste in health research. We aimed to assess the reporting of shared decision making (SDM) interventions. Methods We extracted data from a 2017 Cochrane systematic review whose aim was to determine the effectiveness of interventions to increase the use of SDM by healthcare professionals. In a secondary analysis, we used the 12 items of the Template for Intervention Description and Replication (TIDieR) checklist to analyze quantitative data. We used a conceptual framework for implementation fidelity to analyze qualitative data, which added details to various TIDieR items (e.g. under “what materials?” we also reported on ease of access to materials). We used SAS 9.4 for all analyses. Results Of the 87 studies included in the 2017 Cochrane review, 83 were randomized trials, three were non-randomized trials, and one was a controlled before-and-after study. Items most completely reported were: “brief name” (87/87, 100%), “why” (rationale) (86/87, 99%), and “what” (procedures) (81/87, 93%). The least completely reported items (under 50%) were “materials” (29/87, 33%), “who” (23/87, 26%), and “when and how much” (18/87, 21%), as well as the conditional items: “tailoring” (8/87, 9%), “modifications” (3/87, 4%), and “how well (actual)” (i.e. delivered as planned?) (3/87, 3%). Interventions targeting patients were better reported than those targeting health professionals or both patients and health professionals, e.g. 84% of patient-targeted intervention studies reported “How”, (delivery modes), vs. 67% for those targeting health professionals and 32% for those targeting both. We also reported qualitative analyses for most items. Overall reporting of items for all interventions was 41.5%. Conclusions Reporting on all groups or components of SDM interventions was incomplete in most SDM studies published up to 2017. Our results provide guidance for authors on what elements need better reporting to improve the replicability of their SDM interventions.
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Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review. PLoS One 2020; 15:e0240371. [PMID: 33031475 PMCID: PMC7544054 DOI: 10.1371/journal.pone.0240371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies. Materials and methods We performed a secondary analysis of a Cochrane review of SDM interventions. We extracted study characteristics and their use of sex, gender or related terms (mention; number of categories). We assessed correct use of sex and gender terms using three criteria: “non-binary use”, “use of appropriate categories” and “non-interchangeable use of sex and gender”. We computed the proportion of studies that met all, any or no criteria, and explored associations between criteria met and study characteristics. Results Of 87 included studies, 58 (66.7%) mentioned sex and/or gender. The most mentioned related terms were “female” (60.9%) and “male” (59.8%). Of the 58 studies, authors used sex and gender as binary variables respectively in 36 (62%) and in 34 (58.6%) studies. No study met the criterion “non-binary use”. Authors used appropriate categories to describe sex and gender respectively in 28 (48.3%) and in 8 (13.8%) studies. Of the 83 (95.4%) studies in which sex and/or gender, and/or related terms were mentioned, authors used sex and gender non-interchangeably in 16 (19.3%). No study met all three criteria. Criteria met did not vary according to study characteristics (p>.05). Conclusions In SDM implementation studies, sex and gender terms and concepts are in a state of confusion. Our results suggest the urgency of adopting a standardized use of sex and gender terms and concepts before these considerations can be properly integrated into implementation research.
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Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, Safaeinili N, Fischer M, Shaw JG, Thadaney S, Piccininni G, Lorenz KA, Asch SM, Verghese A, Zulman DM. Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. J Gen Intern Med 2020; 35:2107-2117. [PMID: 31919725 PMCID: PMC7351919 DOI: 10.1007/s11606-019-05525-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). METHODS We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes. RESULTS Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. DISCUSSION Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.
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Affiliation(s)
- Marie C Haverfield
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA. .,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA.
| | - Aaron Tierney
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Schwartz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA
| | | | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Dani L Zionts
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Fischer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonoo Thadaney
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Pham C, Lizarondo L, Karnon J, Aromataris E, Munn Z, Gibb C, Fitridge R, Maddern G. Strategies for implementing shared decision making in elective surgery by health care practitioners: A systematic review. J Eval Clin Pract 2020; 26:582-601. [PMID: 31490593 DOI: 10.1111/jep.13282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To summarize relevant international scientific evidence on strategies aimed at facilitating or improving health care practitioners' adoption of shared decision making in elective surgery. The review evaluated the effectiveness of these strategies and described the characteristics of identified strategies. METHOD A systematic search of the literature was conducted up to March 2019. The review included interventions that targeted patients, health care practitioners, or health systems/organizations. Main outcomes were measures of decision process and decision outcomes. Two independent reviewers conducted study selection, assessed methodological quality and extracted data. RESULTS Fifteen randomized controlled trials, one pseudo-randomized controlled trial, and four quasi-experimental studies were included in this review. The heterogeneity of interventions and the variability of outcomes used to measure the impact of these interventions precluded meta-analysis. All of the interventions included an educational component regarding the medical condition of interest and available treatment options and a supportive component to encourage patients to ask questions and involve themselves in the decision making. Published evidence on shared decision-making interventions in elective surgery is most prevalent in the breast cancer/endocrine and urology specialties, with most studies targeting their shared decision-making interventions at the patient population. The use of multiple media components within an intervention including interactive video appeared to improve patient satisfaction with the shared decision-making process. CONCLUSIONS The use of well-developed educational information provided through interactive multimedia, computer or DVD based, may enhance the decision-making process. The evidence suggests that such multimedia can be used prior to the surgical consultation, presenting medical and surgical information relevant to the upcoming consultation. A decision and communication aid also appears to be an effective method to support the surgeon in patient participation and involvement in the decision-making process.
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Affiliation(s)
- Clarabelle Pham
- College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, SA, Australia.,School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lucylynn Lizarondo
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Edoardo Aromataris
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Zachary Munn
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Catherine Gibb
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Robert Fitridge
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Guy Maddern
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Consensus Recommendations for the Use of Simulation in Therapeutic Patient Education. ACTA ACUST UNITED AC 2020; 15:30-38. [DOI: 10.1097/sih.0000000000000401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Coates D, Clerke T. Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:100-119. [PMID: 32433322 DOI: 10.1097/ceh.0000000000000289] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. METHOD A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. RESULTS The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. DISCUSSION Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
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Affiliation(s)
- Dominiek Coates
- Dr. Coates: Senior Research Fellow, University of Technology Sydney, Faculty of Health, Sydney, Australia.Clerke: Project Officer, Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia
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12
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Biggs K, Hind D, Bradburn M, Swaby L, Brown S. Design, planning and implementation lessons learnt from a surgical multi-centre randomised controlled trial. Trials 2019; 20:620. [PMID: 31675992 PMCID: PMC6823948 DOI: 10.1186/s13063-019-3649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 08/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Increasingly, pragmatic randomised controlled trials are being used to evaluate surgical interventions, although they present particular difficulties in regards to recruitment and retention. Methods Procedures and processes related to implementation of a multi-centre pragmatic surgical randomised controlled trial are discussed. In this surgical trial, forecasting of consent rates based on similar trials and micro-costing of study activities with research partners were undertaken and a video was produced targeting recruiting staff with the aim of aiding recruitment. The baseline assessments were reviewed to ensure the timing did not impact on the outcome. Attrition due to procedure waiting time was monitored and data were triangulated for the primary outcome to ensure adequate follow-up data. Results Forecasting and costing ensured that the recruitment window was of adequate length and adequate resource was available for study procedures at multiple clinics in each hospital. Recruiting staff found the recruitment video useful. The comparison of patient-reported data collected prior to randomisation and prior to treatment provided confidence in the baseline data. Knowledge of participant dropout due to delays in treatment meant we were able to increase the recruitment target in a timely fashion, and along with the triangulation of data sources, this ensured adequate follow-up of randomised participants. Conclusions This paper provides a range of evidence-based and experience-based approaches which, collectively, resulted in meeting our study objectives and from which lessons may be transferable. Trial registration ISRCTN, ISRCTN41394716. Registered on 10 May 2012. UKCRN Study ID: 12486.
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Affiliation(s)
- Katie Biggs
- Sheffield Clinical Trials Research Unit (CTRU), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK.
| | - Daniel Hind
- Sheffield Clinical Trials Research Unit (CTRU), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK
| | - Mike Bradburn
- Sheffield Clinical Trials Research Unit (CTRU), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK
| | - Lizzie Swaby
- Sheffield Clinical Trials Research Unit (CTRU), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK
| | - Steve Brown
- Department of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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Sisk BA, Schulz GL, Mack JW, Yaeger L, DuBois J. Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets. PLoS One 2019; 14:e0221536. [PMID: 31437262 PMCID: PMC6705762 DOI: 10.1371/journal.pone.0221536] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background Improving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology. Methods Systematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000–October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework. Findings Eighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies. Conclusions Most communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ginny L. Schulz
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Lauren Yaeger
- Becker Library, Washington University School of Medicine, St. Louis, MO, United States of America
| | - James DuBois
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of Ameica
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Fischer F, Helmer S, Rogge A, Arraras JI, Buchholz A, Hannawa A, Horneber M, Kiss A, Rose M, Söllner W, Stein B, Weis J, Schofield P, Witt CM. Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research. BMC Cancer 2019; 19:808. [PMID: 31412805 PMCID: PMC6694634 DOI: 10.1186/s12885-019-6022-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies. METHODS To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges. RESULTS Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants' training evaluation, their communication confidence, observed communication skills and patients' overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level). CONCLUSIONS Measuring the effects of training programmes aimed at improving health care professionals' communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible.
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Affiliation(s)
- F. Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Helmer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A. Rogge
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J. I. Arraras
- Radiotherapeutic Oncology Department & Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A. Buchholz
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre, Hamburg, Germany
| | - A. Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M. Horneber
- Department of Internal Medicine, Divisions of Pneumology and Oncology/Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
| | - A. Kiss
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - M. Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, USA
| | - W. Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - B. Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - J. Weis
- Comprehensive Cancer Center, Department of Self-Help Research, Faculty of Medicine and Medical Center University of Freiburg, Freiburg, Germany
| | - P. Schofield
- Department of Psychology, Swinburne University, Melbourne, Victoria Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria Australia
| | - C. M. Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD USA
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Wagner A, Radionova N, Rieger MA, Siegel A. Patient Education and Continuing Medical Education to Promote Shared Decision-Making. A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142482. [PMID: 31336828 PMCID: PMC6678248 DOI: 10.3390/ijerph16142482] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
Background: Over recent years, the use of decision aids to promote shared decision-making have been examined. Studies on patient education and on continuing medical education for physicians are less common. This review analyzes intervention and evaluation studies on patient education and continuing medical education which aim to enhance shared decision-making. The following study parameters are of interest: Study designs, objectives, numbers of participants in the education courses, interventions, primary results, and quality of the studies. Methods: We systematically searched for suitable studies in two databases (Pubmed and the Cochrane Database of Systematic Reviews) from the beginning of April through to mid-June 2016. Results: 16 studies from a total of 462 hits were included: Three studies on patient education and 13 studies on continuing medical education for physicians. Overall, the study parameters were heterogeneous. Major differences were found between the courses; how the courses were conducted, their length, and participants. Conclusions: The differences found in the studies made it difficult to compare the interventions and the results. There is a need for studies that systematically evaluate and further develop interventions in this area to promote shared decision-making.
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Affiliation(s)
- Anke Wagner
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
| | - Natalia Radionova
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
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Müller E, Strukava A, Scholl I, Härter M, Diouf NT, Légaré F, Buchholz A. Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies. BMJ Open 2019; 9:e026488. [PMID: 31230005 PMCID: PMC6596948 DOI: 10.1136/bmjopen-2018-026488] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/27/2019] [Accepted: 06/06/2019] [Indexed: 01/16/2023] Open
Abstract
DESIGN AND OBJECTIVES We performed a systematic review of studies evaluating healthcare provider (HCP) trainings in shared decision-making (SDM) to analyse their evaluation strategies. SETTING AND PARTICIPANTS HCP trainings in SDM from all healthcare settings. METHODS We searched scientific databases (Medline, PsycInfo, CINAHL), performed reference and citation tracking, contacted experts in the field and scanned the Canadian inventory of SDM training programmes for healthcare professionals. We included articles reporting data of summative evaluations of HCP trainings in SDM. Two reviewers screened records, assessed full-text articles, performed data extraction and assessed study quality with the integrated quality criteria for review of multiple study designs (ICROMS) tool. Analysis of evaluation strategies included data source use, use of unpublished or published measures and coverage of Kirkpatrick's evaluation levels. An evaluation framework based on Kirkpatrick's evaluation levels and the Quadruple Aim framework was used to categorise identified evaluation outcomes. RESULTS Out of 7234 records, we included 41 articles reporting on 30 studies: cluster-randomised (n=8) and randomised (n=9) controlled trials, controlled (n=1) and non-controlled (n=7) before-after studies, mixed-methods (n=1), qualitative (n=1) and post-test (n=3) studies. Most studies were conducted in the USA (n=9), Germany (n=8) or Canada (n=7) and evaluated physician trainings (n=25). Eleven articles met ICROMS quality criteria. Almost all studies (n=27) employed HCP-reported outcomes for training evaluation and most (n=19) additionally used patient-reported (n=12), observer-rated (n=10), standardised patient-reported (n=2) outcomes or training process and healthcare data (n=10). Most studies employed a mix of unpublished and published measures (n=17) and covered two (n=12) or three (n=10) Kirkpatrick's levels. Identified evaluation outcomes covered all categories of the proposed framework. CONCLUSIONS Strategies to evaluate HCP trainings in SDM varied largely. The proposed evaluation framework maybe useful to structure future evaluation studies, but international agreement on a core set of outcomes is needed to improve evidence. PROSPERO REGISTRATION NUMBER CRD42016041623.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Strukava
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ndeye Thiab Diouf
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Blackmore A, Kasfiki EV, Purva M. Simulation-based education to improve communication skills: a systematic review and identification of current best practice. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:159-164. [PMID: 35519010 PMCID: PMC8990192 DOI: 10.1136/bmjstel-2017-000220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/03/2022]
Abstract
Background Good communication in healthcare between professionals and between professionals and patients is important in delivering high-quality care. Evidence of translation of technical skills taught through simulation into the clinical environment has been demonstrated, but the evidence for the impact of communication skills is less well known. Objectives To identify and critically appraise the evidence for the impact of communication taught through simulation-based education (SBE) and use this evidence to suggest a model for future SBE interventions for communication skills. Study selection MEDLINE, CINAHL, EMBASE and PsycINFO were searched for articles pertaining to communication skills taught through simulation. A content expert was consulted to suggest additional studies. 1754 studies were initially screened for eligibility, with 274 abstracts screened further. 147 full-text articles were further assessed for eligibility, with 79 of these excluded. The remaining 68 studies were reviewed and 18 studies were included in the qualitative synthesis as studies designed to show benefits beyond the simulation centre. Findings The 18 identified studies with an impact at a Kirkpatrick level of ≥3, are analysed; 4 looking specifically at communication between healthcare professionals and 14 looking at communication between health professionals and patients or relatives. Conclusions There is some evidence that the improvements in communication taught through simulation can be translated into benefits measurable beyond the simulation centre, but this evidence is limited due to the way that most of the studies are designed. We suggest a model for SBE aimed at teaching communication skills that is informed by the current evidence and takes into account the need to collect higher-level outcome data.
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Affiliation(s)
| | | | - Makani Purva
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner‐Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7:CD006732. [PMID: 30025154 PMCID: PMC6513543 DOI: 10.1002/14651858.cd006732.pub4] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and five other databases on 15 June 2017. We also searched two clinical trials registries and proceedings of relevant conferences. We checked reference lists and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized and non-randomized trials, controlled before-after studies and interrupted time series studies evaluating interventions for increasing the use of SDM in which the primary outcomes were evaluated using observer-based or patient-reported measures. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane.We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 87 studies (45,641 patients and 3113 healthcare professionals) conducted mainly in the USA, Germany, Canada and the Netherlands. Risk of bias was high or unclear for protection against contamination, low for differences in the baseline characteristics of patients, and unclear for other domains.Forty-four studies evaluated interventions targeting patients. They included decision aids, patient activation, question prompt lists and training for patients among others and were administered alone (single intervention) or in combination (multifaceted intervention). The certainty of the evidence was very low. It is uncertain if interventions targeting patients when compared with usual care increase SDM whether measured by observation (standardized mean difference (SMD) 0.54, 95% confidence interval (CI) -0.13 to 1.22; 4 studies; N = 424) or reported by patients (SMD 0.32, 95% CI 0.16 to 0.48; 9 studies; N = 1386; risk difference (RD) -0.09, 95% CI -0.19 to 0.01; 6 studies; N = 754), reduce decision regret (SMD -0.10, 95% CI -0.39 to 0.19; 1 study; N = 212), improve physical (SMD 0.00, 95% CI -0.36 to 0.36; 1 study; N = 116) or mental health-related quality of life (QOL) (SMD 0.10, 95% CI -0.26 to 0.46; 1 study; N = 116), affect consultation length (SMD 0.10, 95% CI -0.39 to 0.58; 2 studies; N = 224) or cost (SMD 0.82, 95% CI 0.42 to 1.22; 1 study; N = 105).It is uncertain if interventions targeting patients when compared with interventions of the same type increase SDM whether measured by observation (SMD 0.88, 95% CI 0.39 to 1.37; 3 studies; N = 271) or reported by patients (SMD 0.03, 95% CI -0.18 to 0.24; 11 studies; N = 1906); (RD 0.03, 95% CI -0.02 to 0.08; 10 studies; N = 2272); affect consultation length (SMD -0.65, 95% CI -1.29 to -0.00; 1 study; N = 39) or costs. No data were reported for decision regret, physical or mental health-related QOL.Fifteen studies evaluated interventions targeting healthcare professionals. They included educational meetings, educational material, educational outreach visits and reminders among others. The certainty of evidence is very low. It is uncertain if these interventions when compared with usual care increase SDM whether measured by observation (SMD 0.70, 95% CI 0.21 to 1.19; 6 studies; N = 479) or reported by patients (SMD 0.03, 95% CI -0.15 to 0.20; 5 studies; N = 5772); (RD 0.01, 95%C: -0.03 to 0.06; 2 studies; N = 6303); reduce decision regret (SMD 0.29, 95% CI 0.07 to 0.51; 1 study; N = 326), affect consultation length (SMD 0.51, 95% CI 0.21 to 0.81; 1 study, N = 175), cost (no data available) or physical health-related QOL (SMD 0.16, 95% CI -0.05 to 0.36; 1 study; N = 359). Mental health-related QOL may slightly improve (SMD 0.28, 95% CI 0.07 to 0.49; 1 study, N = 359; low-certainty evidence).It is uncertain if interventions targeting healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.30, 95% CI -1.19 to 0.59; 1 study; N = 20) or reported by patients (SMD 0.24, 95% CI -0.10 to 0.58; 2 studies; N = 1459) as the certainty of the evidence is very low. There was insufficient information to determine the effect on decision regret, physical or mental health-related QOL, consultation length or costs.Twenty-eight studies targeted both patients and healthcare professionals. The interventions used a combination of patient-mediated and healthcare professional directed interventions. Based on low certainty evidence, it is uncertain whether these interventions, when compared with usual care, increase SDM whether measured by observation (SMD 1.10, 95% CI 0.42 to 1.79; 6 studies; N = 1270) or reported by patients (SMD 0.13, 95% CI -0.02 to 0.28; 7 studies; N = 1479); (RD -0.01, 95% CI -0.20 to 0.19; 2 studies; N = 266); improve physical (SMD 0.08, -0.37 to 0.54; 1 study; N = 75) or mental health-related QOL (SMD 0.01, -0.44 to 0.46; 1 study; N = 75), affect consultation length (SMD 3.72, 95% CI 3.44 to 4.01; 1 study; N = 36) or costs (no data available) and may make little or no difference to decision regret (SMD 0.13, 95% CI -0.08 to 0.33; 1 study; low-certainty evidence).It is uncertain whether interventions targeting both patients and healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.29, 95% CI -1.17 to 0.60; 1 study; N = 20); (RD -0.04, 95% CI -0.13 to 0.04; 1 study; N = 134) or reported by patients (SMD 0.00, 95% CI -0.32 to 0.32; 1 study; N = 150 ) as the certainty of the evidence was very low. There was insuffient information to determine the effects on decision regret, physical or mental health-related quality of life, or consultation length or costs. AUTHORS' CONCLUSIONS It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low.
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Affiliation(s)
- France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Rhéda Adekpedjou
- Université LavalDepartment of Social and Preventive MedicineQuebec CityQuebecCanada
| | - Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | - Stéphane Turcotte
- Centre de Recherche du CHU de Québec (CRCHUQ) ‐ Hôpital St‐François d'Assise10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Jennifer Kryworuchko
- The University of British ColumbiaSchool of NursingT201 2211 Wesbrook MallVancouverBritish ColumbiaCanadaV6T 2B5
| | - Ian D Graham
- University of OttawaSchool of Epidemiology, Public Health and Preventative Medicine600 Peter Morand CrescentOttawaONCanada
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Mary C Politi
- Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery660 S Euclid AveSt LouisMissouriUSA63110
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Glyn Elwyn
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Norbert Donner‐Banzhoff
- University of MarburgDepartment of Family Medicine / General PracticeKarl‐von‐Frisch‐Str. 4MarburgGermanyD‐35039
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Bieber C, Nicolai J, Gschwendtner K, Müller N, Reuter K, Buchholz A, Kallinowski B, Härter M, Eich W. How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:708-715. [PMID: 27966192 PMCID: PMC5949132 DOI: 10.1007/s13187-016-1146-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification. TRIAL REGISTRATION German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.
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Affiliation(s)
- Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany.
| | - Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
- Department of Psychology III - Cognition and Individual Differences, University of Mannheim, Mannheim, Germany
| | - Kathrin Gschwendtner
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Nicole Müller
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
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Mills N, Gaunt D, Blazeby JM, Elliott D, Husbands S, Holding P, Rooshenas L, Jepson M, Young B, Bower P, Tudur Smith C, Gamble C, Donovan JL. Training health professionals to recruit into challenging randomized controlled trials improved confidence: the development of the QuinteT randomized controlled trial recruitment training intervention. J Clin Epidemiol 2018; 95:34-44. [PMID: 29191445 PMCID: PMC5844671 DOI: 10.1016/j.jclinepi.2017.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/31/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to describe and evaluate a training intervention for recruiting patients to randomized controlled trials (RCTs), particularly for those anticipated to be difficult for recruitment. STUDY DESIGN AND SETTING One of three training workshops was offered to surgeons and one to research nurses. Self-confidence in recruitment was measured through questionnaires before and up to 3 months after training; perceived impact of training on practice was assessed after. Data were analyzed using two-sample t-tests and supplemented with findings from the content analysis of free-text comments. RESULTS Sixty-seven surgeons and 32 nurses attended. Self-confidence scores for all 10 questions increased after training [range of mean scores before 5.1-6.9 and after 6.9-8.2 (scale 0-10, all 95% confidence intervals are above 0 and all P-values <0.05)]. Awareness of hidden challenges of recruitment following training was high-surgeons' mean score 8.8 [standard deviation (SD), 1.2] and nurses' 8.4 (SD, 1.3) (scale 0-10); 50% (19/38) of surgeons and 40% (10/25) of nurses reported on a 4-point Likert scale that training had made "a lot" of difference to their RCT discussions. Analysis of free text revealed this was mostly in relation to how to convey equipoise, explain randomization, and manage treatment preferences. CONCLUSION Surgeons and research nurses reported increased self-confidence in discussing RCTs with patients, a raised awareness of hidden challenges and a positive impact on recruitment practice following QuinteT RCT Recruitment Training. Training will be made more available and evaluated in relation to recruitment rates and informed consent.
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Affiliation(s)
- Nicola Mills
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Daisy Gaunt
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Jane M Blazeby
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Daisy Elliott
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Samantha Husbands
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Leila Rooshenas
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marcus Jepson
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Institute of Psychology Health and Society, University of Liverpool, Block B, Waterhouse Building, Brownlow Street, Liverpool L69 3GL, UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Centre for Primary Care, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - Catrin Tudur Smith
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Jenny L Donovan
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), University Hospitals Bristol NHS Foundation Trust, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
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Truglio-Londrigan M, Slyer JT. Shared Decision-Making for Nursing Practice: An Integrative Review. Open Nurs J 2018; 12:1-14. [PMID: 29456779 PMCID: PMC5806202 DOI: 10.2174/1874434601812010001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/16/2017] [Accepted: 12/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. OBJECTIVE To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. METHODS An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. RESULTS Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. CONCLUSION A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.
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Affiliation(s)
- Marie Truglio-Londrigan
- Pace University, College of Health Professions, Lienhard School of Nursing 861 Bedford Road Pleasantville, NY 10570, USA
| | - Jason T. Slyer
- Clinical Assistant Professor, Pace University, College of Health Professions, Lienhard School of Nursing 163 William Street, 5 Floor New York, NY 10036, USA
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Grady A, Carey M, Bryant J, Sanson-Fisher R, Hobden B. A systematic review of patient-practitioner communication interventions involving treatment decisions. PATIENT EDUCATION AND COUNSELING 2017; 100:199-211. [PMID: 27682739 DOI: 10.1016/j.pec.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To examine the: 1) methodological quality of interventions examining strategies to improve patient-practitioner communication involving treatment decisions; 2) effectiveness of strategies to improve patient-practitioner communication involving treatment decisions; and 3) types of treatment decisions (emergency/non-emergency) in the included studies. METHODS Medline, PsychINFO, CINAHL, and Embase were searched to identify intervention studies. To be included, studies were required to examine patient-practitioner communication related to decision making about treatment. Study methodological quality was assessed using Cochrane's Effective Practice and Organisation of Care risk of bias criteria. Study design, sample characteristics, intervention details, and outcomes were extracted. RESULTS Eleven studies met the inclusion criteria. No studies were rated low risk on all nine risk of bias criteria. Two of the three interventions aimed at changing patient behaviour, two of the five practitioner directed, and one of the three patient-practitioner directed interventions demonstrated an effect on decision-making outcomes. No studies examined emergency treatment decisions. CONCLUSIONS Existing studies have a high risk of bias and are poorly reported. There is some evidence to suggest patient-directed interventions may be effective in improving decision-making outcomes. PRACTICE IMPLICATIONS It is imperative that an evidence-base is developed to inform clinical practice.
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Affiliation(s)
- Alice Grady
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Public Health, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Public Health, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Public Health, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Public Health, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Breanne Hobden
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Public Health, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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Härter M, Buchholz A, Nicolai J, Reuter K, Komarahadi F, Kriston L, Kallinowski B, Eich W, Bieber C. Shared Decision Making and the Use of Decision Aids. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:672-9. [PMID: 26517595 DOI: 10.3238/arztebl.2015.0672] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND In shared decision making (SDM), the patient and the physician reach decisions in partnership. We conducted a trial of SDM training for physicians who treat patients with cancer. METHODS Physicians who treat patients with cancer were invited to participate in a cluster-randomized trial and carry out SDM together with breast or colon cancer patients who faced decisions about their treatment. Decision-related physician-patient conversations were recorded. The patients filled out questionnaires immediately after the consultations (T1) and three months later (T2). The primary endpoints were the patients' confidence in and satisfaction with the decisions taken. The secondary endpoints were the process of decision making, anxiety, depression, quality of life, and externally assessed physician competence in SDM. The physicians in the intervention group underwent 12 hours of training in SDM, including the use of decision aids. RESULTS Of the 900 physicians invited to participated in the trial, 105 answered the invitation. 86 were randomly assigned to either the intervention group or the control group (44 and 42 physicians, respectively); 33 of the 86 physicians recruited at least one patient for the trial. A total of 160 patients participated in the trial, of whom 55 were treated by physicians in the intervention group. There were no intergroup differences in the primary endpoints. Trained physicians were more competent in SDM (Cohen's d = 0.56; p<0.05). Patients treated by trained physicians had lower anxiety and depression scores immediately after the consultation (d = -0.12 and -0.14, respectively; p<0.10), and markedly lower anxiety and depression scores three months later (d = -0.94 and -0.67, p<0.01). CONCLUSION When physicians treating cancer patients improve their competence in SDM by appropriate training, their patients may suffer less anxiety and depression. These effects merit further study.
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Affiliation(s)
- Martin Härter
- Department of Medical Psychology at the University Medical Center Hamburg-Eppendorf, Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Celenus-Kliniken GmbH, Offenburg, Practice for Gastroenterology & Oncology, Schwetzingen
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Yoon S, Chan M, Hung WK, Ying M, Or A, Lam WWT. Communicative characteristics of interactions between surgeons and Chinese women with breast cancer in oncology consultation: a conversation analysis. Health Expect 2015; 18:2825-40. [PMID: 25200668 PMCID: PMC5810679 DOI: 10.1111/hex.12260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While previous studies have analysed features of interaction in cancer consultations using observational coding frames, relatively little attention is being given to how actual interactions are sequentially organized and achieved by participants in the course of talk-in-interaction. Research into the interactional practices in consultations, which involves Chinese patients, is largely absent. OBJECTIVE To provide insight into the talk-in-interaction in surgical-oncology consultations in the context of a Chinese medical setting. METHODS Thirty-one consultations involving 31 patients with breast cancer and eight surgeons were videotaped. The recordings were transcribed verbatim and analysed using conversation analysis. RESULTS The manner in which surgeons delivered the diagnostic results was fairly similar across all the consultations. Most surgeons gave the diagnosis in a very straightforward and abrupt manner at the outset of the consultation with no mitigation. While patients in our study conformed to the traditional information giving and receiving roles, how information was presented by surgeons shaped the subsequent sequential organization of surgeon-patient interaction and turn-taking patterns. More importantly, there was a tendency by the surgeons to move from issues of psychosocial nature to clinical matters regardless of the topics taken up in the specific encounter. CONCLUSIONS This study demonstrated the potential of conversation analysis as a context-sensitive method that enabled researchers to gain a more thorough understanding of dynamics of interaction in cancer consultations, thereby informing training interventions for surgeons. Our findings underscore the importance of discursive practices in shaping and encouraging (or discouraging) patient participation in oncology consultation.
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Affiliation(s)
- Sungwon Yoon
- Centre for Psycho‐Oncology Research and TrainingSchool of Public HealthThe University of Hong KongHong Kong
| | - Miranda Chan
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Wai Ka Hung
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Marcus Ying
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Amy Or
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Wendy WT Lam
- Centre for Psycho‐Oncology Research and TrainingSchool of Public HealthThe University of Hong KongHong Kong
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Clayman ML, Bylund CL, Chewning B, Makoul G. The Impact of Patient Participation in Health Decisions Within Medical Encounters. Med Decis Making 2015; 36:427-52. [DOI: 10.1177/0272989x15613530] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/18/2015] [Indexed: 02/01/2023]
Abstract
Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.
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Affiliation(s)
- Marla L. Clayman
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Carma L. Bylund
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Betty Chewning
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Gregory Makoul
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
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Oliveira VC, Ferreira ML, Pinto RZ, Filho RF, Refshauge K, Ferreira PH. Effectiveness of Training Clinicians' Communication Skills on Patients' Clinical Outcomes: A Systematic Review. J Manipulative Physiol Ther 2015; 38:601-16. [DOI: 10.1016/j.jmpt.2015.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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Townsend D, Mills N, Savović J, Donovan JL. A systematic review of training programmes for recruiters to randomised controlled trials. Trials 2015; 16:432. [PMID: 26416143 PMCID: PMC4587840 DOI: 10.1186/s13063-015-0908-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment to randomised controlled trials (RCTs) is often difficult. Clinician related factors have been implicated as important reasons for low rates of recruitment. Clinicians (doctors and other health professionals) can experience discomfort with some underlying principles of RCTs and experience difficulties in conveying them positively to potential trial participants. Recruiter training has been suggested to address identified problems but a synthesis of this research is lacking. The aim of our study was to systematically review the available evidence on training interventions for recruiters to randomised trials. METHODS Studies that evaluated training programmes for trial recruiters were included. Those that provided only general communication training not linked to RCT recruitment were excluded. Data extraction and quality assessment were completed by two reviewers independently, with a third author where necessary. RESULTS Seventeen studies of 9615 potentially eligible titles and abstracts were included in the review: three randomised controlled studies, two non-randomised controlled studies, nine uncontrolled pre-test/post-test studies, two qualitative studies, and a post-training questionnaire survey. Most studies were of moderate or weak quality. Training programmes were mostly set within cancer trials, and usually consisted of workshops with a mix of health professionals over one or two consecutive days covering generic and trial specific issues. Recruiter training programmes were well received and some increased recruiters' self-confidence in communicating key RCT concepts to patients. There was, however, little evidence that this training increased actual recruitment rates or patient understanding, satisfaction, or levels of informed consent. CONCLUSIONS There is a need to develop recruiter training programmes that can lead to improved recruitment and informed consent in randomised trials.
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Affiliation(s)
- Daisy Townsend
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Nicola Mills
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Jelena Savović
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Cipolat Mis C, Truccolo I, Ravaioli V, Cocchi S, Gangeri L, Mosconi P, Drace C, Pomicino L, Paradiso A, De Paoli P. Making patient centered care a reality: a survey of patient educational programs in Italian Cancer Research and Care Institutes. BMC Health Serv Res 2015. [PMID: 26223861 PMCID: PMC4518580 DOI: 10.1186/s12913-015-0962-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Educational intervention represents an essential element of care for cancer patients; while several single institutions develop their own patient education (PE) programs on cancer, little information is available on the effective existence of PE programs at the level of research and care institutes. In Italy such institutes - Istituti di Ricovero e Cura a Carattere Scientifico - are appointed by the Ministry of Health, and 11 (Cancer Research & Care Istitute-CRCI) of the 48 are specific for cancer on the basis of specific requirements regarding cancer care, research and education. Therefore, they represent an ideal and homogeneous model through which to investigate PE policies and activities throughout the country. The objective of this study was to assess PE activities in Italian CRCI. Methods We carried out a survey on PE strategies and services through a questionnaire. Four key points were investigated: a) PE as a cancer care priority, b) activities that are routinely part of PE, c) real involvement of the patients, and d) involvement of healthcare workers in PE activities. Results Most CRCI (85 %) completed the survey. All reported having ongoing PE activities, and 4 of the 11 considered PE an institutional activity. More than 90 % of CRCI organize classes and prepare PE handouts, while other PE activities (e.g., Cancer Information Services, mutual support groups) are less frequently part of institutional PE programs. Patients are frequently involved in the organization and preparation of educational activities on the basis of their own needs. Various PE activities are carried out for caregivers in 8 (73 %) out of 11 institutes. Finally, health care workers have an active role in the organization of PE programs, although nurses take part in these activities in only half of CRCI and pharmacists are seldom included. Conclusions The information arising from our research constitutes a necessary framework to identify areas of development and to design new strategies and standards to disseminate the culture of PE. This may ultimately help and stimulate the establishment of institutional integrated PE programs, including policies and interventions that can benefit a significant proportion of cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0962-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Cipolat Mis
- Scientific and Patients Library, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | - I Truccolo
- Scientific and Patients Library, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
| | - V Ravaioli
- Public Relations, Communication and Press Office, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Srl IRCCS, Meldola, Italy.
| | - S Cocchi
- Medical Library, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - L Gangeri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - P Mosconi
- Laboratory for medical research and consumer involvement, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
| | - C Drace
- Familiar Cancer Clinic, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
| | - L Pomicino
- Department of Pediatrics, Institute of Maternal and Child Health, Burlo Garofolo, Trieste, Italy.
| | - A Paradiso
- Experimental Medical Oncology Unit, National Cancer Research Centre, Istituto Tumori'Giovanni Paolo II', Bari, Italy.
| | - P De Paoli
- Scientific Director, CRO National Cancer Institute - IRCCS, Aviano (PN), Italy.
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Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making 2014; 35:114-31. [PMID: 25351843 DOI: 10.1177/0272989x14551638] [Citation(s) in RCA: 709] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite widespread advocacy for shared decision making (SDM), the empirical evidence regarding its effectiveness to improve patient outcomes has not been systematically reviewed. The purpose of this study was to systematically review the empirical evidence linking patient outcomes and SDM, when the decision-making process has been explicitly measured, and to identify under what measurement perspectives SDM is associated with which types of patient outcomes (affective-cognitive, behavioral, and health). DATA SOURCES PubMed (through December 2012) and hand search of article bibliographies. STUDY SELECTION Studies were included if they empirically 1) measured SDM in the context of a patient-clinician interaction and 2) evaluated the relationship between SDM and at least 1 patient outcome. DATA EXTRACTION Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health). DATA SYNTHESIS Thirty-nine studies met inclusion criteria. Thirty-three used patient-reported measures of SDM, 6 used observer-rated measures, and 2 used clinician-reported measures. Ninety-seven unique patient outcomes were assessed; 51% affective-cognitive, 28% behavioral, and 21% health. Only 43% of assessments (n = 42) found a significant and positive relationship between SDM and the patient outcome. This proportion varied by SDM measurement perspective and outcome category. It was found that 52% of outcomes assessed with patient-reported SDM were significant and positive, compared with 21% with observer-rated and 0% with clinician-reported SDM. Regardless of measurement perspective, SDM was most likely to be associated with affective-cognitive patient outcomes (54%), compared with 37% of behavioral and 25% of health outcomes. LIMITATIONS The relatively small number of studies precludes meta-analysis. Because the study inclusion and exclusion criteria required both an empirical measure of SDM and an assessment of the association between that measure and a patient outcome, most included studies were observational in design. CONCLUSIONS SDM, when perceived by patients as occurring, tends to result in improved affective-cognitive outcomes. Evidence is lacking for the association between empirical measures of SDM and patient behavioral and health outcomes.
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Affiliation(s)
- L Aubree Shay
- University of Texas School of Public Health, Center for Health Promotions and Research, San Antonio, TX (LAS)
| | - Jennifer Elston Lafata
- Virginia Commonwealth University, Massey Cancer Center and Department of Social and Behavioral Health, Richmond, VA (JEL)
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Expectations towards medical personnel – a study with infertility clinic patients. HEALTH PSYCHOLOGY REPORT 2014. [DOI: 10.5114/hpr.2014.45197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
Contacts with medical personnel are important for patients’ experiences. The role of physicians’ psychosocial competence was noted in Polish studies, but systematic analyses of infertile patients’ expectations have not been conducted. This study was designed to learn about patients’ views on relationships with medical personnel. It was assumed that: 1) staff involvement in infertility treatment would be reflected in expectations towards persons in different roles, 2) expectations might be related to patients’ gender, duration of infertility, and type of treatment, 3) expectations of couples would be related.<br />
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<b>Participants and procedure</b><br />
Fifty-one married couples filled in a purposely designed questionnaire. Items related to information, attitudes and support were divided into three sections – expectations towards physicians, other medical personnel, psychologists – and were scored on a scale of 1 to 5 points.<br />
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<b>Results</b><br />
No gender effect of duration of treatment, type of infertility or treatment method on expectations was found. Partners expected the same level of information from physicians and the same level of emotional support from psychologists. Other expectations were consistently higher in women. There was a clear division of expectations towards different groups of personnel – the expectation to make the best medical choices was assigned to physicians, while the expectation to provide a supportive relationship and coping skills was assigned to psychologists, but all were expected to respect patients’ privacy, choices and decisions.<br />
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<b>Conclusions</b><br />
The findings indicate the division of expectations towards different groups of personnel, with the tendency of women to articulate their expectations more clearly and strongly, but towards the same aspects of staff functioning as men do.
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Légaré F, Stacey D, Turcotte S, Cossi MJ, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2014:CD006732. [PMID: 25222632 DOI: 10.1002/14651858.cd006732.pub3] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Shared decision making (SDM) can reduce overuse of options not associated with benefits for all and respects patient rights, but has not yet been widely adopted in practice. OBJECTIVES To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM. SEARCH METHODS For this update we searched for primary studies in The Cochrane Library, MEDLINE, EMBASE, CINAHL, the Cochrane Effective Practice and Organisation of Care (EPOC) Specialsied Register and PsycINFO for the period March 2009 to August 2012. We searched the Clinical Trials.gov registry and the proceedings of the International Shared Decision Making Conference. We scanned the bibliographies of relevant papers and studies. We contacted experts in the field to identify papers published after August 2012. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies evaluating interventions to improve healthcare professionals' adoption of SDM where the primary outcomes were evaluated using observer-based outcome measures (OBOM) or patient-reported outcome measures (PROM). DATA COLLECTION AND ANALYSIS The three overall categories of intervention were: interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. Studies in each category were compared to studies in the same category, to studies in the other two categories, and to usual care, resulting in nine comparison groups. Statistical analysis considered categorical and continuous primary outcomes separately. We calculated the median of the standardized mean difference (SMD), or risk difference, and range of effect across studies and categories of intervention. We assessed risk of bias. MAIN RESULTS Thirty-nine studies were included, 38 randomised and one non-randomised controlled trial. Categorical measures did not show any effect for any of the interventions. In OBOM studies, interventions targeting both patients and healthcare professionals had a positive effect compared to usual care (SMD of 2.83) and compared to interventions targeting patients alone (SMD of 1.42). Studies comparing interventions targeting patients with other interventions targeting patients had a positive effect, as did studies comparing interventions targeting healthcare professionals with usual care (SDM of 1.13 and 1.08 respectively). In PROM studies, only three comparisons showed any effect, patient compared to usual care (SMD of 0.21), patient compared to another patient (SDM of 0.29) and healthcare professional compared to another healthcare professional (SDM of 0.20). For all comparisons, interpretation of the results needs to consider the small number of studies, the heterogeneity, and some methodological issues. Overall quality of the evidence for the outcomes, assessed with the GRADE tool, ranged from low to very low. AUTHORS' CONCLUSIONS It is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence. However, any intervention that actively targets patients, healthcare professionals, or both, is better than none. Also, interventions targeting patients and healthcare professionals together show more promise than those targeting only one or the other.
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Affiliation(s)
- France Légaré
- Population Health and Optimal Health Practices Research Axis, CHU de Québec Research Center, Université Laval, 10 Rue de l'Espinay, D6-727, Québec City, Québec, Canada, G1L 3L5
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Butow P, Brown R, Aldridge J, Juraskova I, Zoller P, Boyle F, Wilson M, Bernhard J. Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 2014; 18:2570-83. [PMID: 24975503 DOI: 10.1111/hex.12229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Informed consent is required for both standard cancer treatments and experimental cancer treatments in a clinical trial. Effective and sensitive physician-patient communication about informed consent is difficult to achieve. Our aim was to train doctors in clear, collaborative and ethical communication about informed consent and evaluate the impact of training on doctor behaviour, stress and satisfaction. PARTICIPANTS AND METHODS Participants were 21 oncologists from 10 Australian/New Zealand (ANZ) centres and 41 oncologists from 10 Swiss/German/Austrian (SGA) centres. Oncologists were randomized to participate in a 1-day workshop or not. Patients were recruited before and after the training. Doctors were asked to submit 1-2 audiotaped consultations before and after training. Doctors completed outcome measures before and after completing the post-training cohort recruitment. RESULTS Ninety-five consultation interactions were audiotaped. Doctors strongly endorsed the training. ANZ intervention doctors demonstrated a significant increase in collaborative communication (P = 0.03). There was no effect of training on other doctor behaviours. Trained doctors did not demonstrate reduced stress and burnout. Patient outcomes are presented elsewhere. CONCLUSIONS Training can improve some aspects of the process of obtaining informed consent. Methods to increase the impact of training are required and may include longer training and more intensive follow-up.
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Affiliation(s)
- P Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Aldridge
- International Breast Cancer Study Group (IBCSG) Statistical Centre, Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - P Zoller
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Boyle
- Pam McLean Centre, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - M Wilson
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Bernhard
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Mazouni C, Deneuve J, Arnedos M, Prenois F, Saghatchian M, André F, Bourgier C, Delaloge S. Decision-making from multidisciplinary team meetings to the bedside: Factors influencing the recruitment of breast cancer patients into clinical trials. Breast 2014; 23:170-4. [DOI: 10.1016/j.breast.2013.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/05/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022] Open
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Perceived usefulness of data entry tools in medical encounters: a survey. J Med Syst 2013; 37:9988. [PMID: 24158426 DOI: 10.1007/s10916-013-9988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
Electronic Health Records allows direct data entry and is an important factor for accurate diagnosis. However, two drawbacks of this system is the time needed to create them, which can reduce health care professional productivity, and the fact that it is error prone. It is important, therefore, to select the most appropriate methods and tools for data entry by the health care providers at the point of care in order to minimize a loss of productivity. The study aims to understand health care professionals' perceptions of the data entry process, and determine the appropriate methods, tools and functions that would facilitate the process, minimize loss of productivity and improve quality. A questionnaire which consisting of 18 basic questions (including demographic data) was posted on a web site which hosts questionnaires, on an established online community space and also mailed to health care professionals who are working in various hospitals for a duration of 10 months. Totally, 533 medical care professionals who are primarily from Turkey participated in the survey, of which 284 were medical doctors, 127 were nurses and the rest, other medical professionals. While the clear majority of participants involved in data entry use keyboard and mouse, most expressed a preference for more convenient methods, such as voice recognition or touch screen. Furthermore, physicians reported rarely spending more than 15 min for each consultation and conducting 21-30 examinations a day. The main motivation for creating an efficient direct data entry is to increase time allowed for patient examination, and to improve accuracy of diagnosis. Despite a heavy workload, health care professionals are very receptive to the idea of using a convenient data entry tool and keeping electronic patient records. Emergent data entry technologies in health sector can improve the quality of examinations, physicians' productivity and can decrease the percentage of medical misdiagnosis.
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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Bernhard J, Aldridge J, Butow PN, Zoller P, Brown R, Smith A, Juraskova I. Patient-doctor agreement on recall of clinical trial discussion across cultures. Ann Oncol 2013; 24:391-397. [PMID: 23019277 PMCID: PMC3551480 DOI: 10.1093/annonc/mds288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose was to investigate patient-doctor agreement on clinical trial discussion cross-culturally. METHODS In the International Breast Cancer Study Group Trial 33-03 on shared decision-making for early breast cancer in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centers, doctor and patient characteristics plus doctor stress and burnout were assessed. Within 2 weeks post-consultation about treatment options, the doctor and patient reported independently, whether a trial was discussed. Odds ratios of agreement for covariables were estimated by generalized estimating equations for each language cohort, with doctor as a random effect. RESULTS In ANZ, 21 doctors and 339 patients were eligible; in SGA, 41 doctors and 427 patients. In cases where the doctor indicated 'no trial discussed', 82% of both ANZ and SGA patients agreed; if the doctor indicated 'trial discussed', 50% of ANZ and 38% of SGA patients agreed, respectively. Factors associated with higher agreement were: low tumor grade and fewer patients recruited into clinical trials in SGA; public institution, patient born in ANZ (versus other), higher doctor depersonalization and personal accomplishment in ANZ. CONCLUSION There is discordance between oncologists and their patients regarding clinical trial discussion, particularly when the doctor indicates that a trial was discussed. Factors contributing to this agreement vary by culture.
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Affiliation(s)
- J Bernhard
- IBCSG Coordinating Center, Bern; Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - J Aldridge
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA
| | - P N Butow
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | | | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, USA
| | - A Smith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - I Juraskova
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED)
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