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Spinnewijn L, Scheele F, Braat D, Aarts J. Assessing the educational quality of shared decision-making interventions for residents: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 123:108187. [PMID: 38355382 DOI: 10.1016/j.pec.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many studies on educational interventions to enhance residents' shared decision-making (SDM) skills show limited improvement in SDM skills and clinical outcomes. One plausible explanation for these suboptimal results is the insufficient emphasis on the educational quality of training interventions. METHODS This review evaluates interventions' educational quality using an evaluation framework based on a previous study on effective skills transfer and a well-known SDM model. A systematic review was conducted, searching three databases until December 13, 2022. We assessed study quality by calculating MERSQI scores, examined the levels of study effects based on Kirkpatrick's model, and applied our evaluation framework to assess the interventions' educational quality. Given the heterogeneity among the studies, a meta-analysis was not feasible. RESULTS Twenty-six studies were included. Role-play and feedback were common training characteristics (65% and 54% of interventions). Only four studies (15%) met our framework's high educational quality threshold. No correlation was found between MERSQI scores and educational quality. CONCLUSIONS This review is a valuable attempt to assess the educational quality of SDM interventions beyond measuring study outcomes. PRACTICE IMPLICATIONS Future evaluation frameworks should consider study results, training characteristics, and training content. Our framework offers a sound basis for such an evaluation framework.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands; VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands.
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands; OLVG hospital, Department of Healthcare Education, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
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Sanatani M, Muir F. Oncology residents' experiences of decision-making in a clinical learning environment: a phenomenological study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1371-1390. [PMID: 37076598 DOI: 10.1007/s10459-023-10223-0] [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: 08/18/2022] [Accepted: 03/05/2023] [Indexed: 05/03/2023]
Abstract
Oncology residents routinely engage in ethically complex decision-making discussions with patients, while observing and interacting with their teaching consultant. If clinical competency in oncology decision-making guidance is to be taught deliberately and effectively, it is necessary to understand resident experiences in this context to develop appropriate educational and faculty development initiatives. Four junior and two senior postgraduate oncology residents participated in semi-structured interviews during October and November 2021 which explored their experiences of real-world decision-making scenarios. Van Manen's phenomenology of practice was used in an interpretivist research paradigm. Transcripts were analysed to articulate essential experiential themes, and composite vocative narratives were created. Three essential themes were identified: (1) residents often endorsed different decision-making approaches than supervising consultants, (2) residents experienced inner conflict, and (3) residents struggled to find their own approach to decision-making. Residents experienced being torn between a perceived obligation to defer to consultant directives, and a desire for increasing ownership of decision-making while not feeling empowered to discuss their opinions with the consultants. Residents described their experiences around ethical position awareness during decision-making in a clinical teaching context as challenging, with experiences suggesting moral distress combined with inadequate psychological safety to address ethical conflicts and unresolved questions of decision ownership with supervisors. These results suggest the need for enhanced dialogue and more research to reduce resident distress during oncology decision-making. Future research should be aimed at discovering novel ways in which residents and consultants could interact in a unique clinical learning context including graduated autonomy, a hierarchical gradient, ethical positions, physician values, and sharing of responsibility.
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Affiliation(s)
- Michael Sanatani
- Division of Medical Oncology, Department of Oncology, Schulich School of Dentistry & Medicine, Western University, Room A3-915, 800 Commissioners Road East, London, ON, Canada.
| | - Fiona Muir
- School of Medicine, University of Dundee, Dundee, Scotland
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Baldt B, Slunecko T. Shared Medical Decision Making Reconsidered: Challenging an Overly Cognitivist Perspective with a Linguistic Approach. HEALTH COMMUNICATION 2023; 38:2281-2291. [PMID: 35635085 DOI: 10.1080/10410236.2022.2065736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article critically examines the four patterns of shared medical decision making (physician-dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated) suggested by Lippa et al. (2017). The aim of the study is to challenge these patterns with a new data set of conversations between physicians and cancer patients in a hospital ward. We recorded 13 physician-patient-conversations during the medical round in an Austrian hospital, which in total lasted about 1.5 h (language: German). We then categorized the medical decisions found in the data following Lippa et al.'s instructions and further analyzed them with a fine-grained linguistic approach. The study revealed no patient-dominated decisions and one decision, which could not be categorized with one of the patterns. Results from the linguistic approach call into question the generalizability, distinctiveness and validity of the patterns. Finally, the relationship between shared decision making and clinical distributed cognition is discussed.
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Affiliation(s)
- Bettina Baldt
- Department of Systematic Theology and Ethics, University of Vienna
| | - Thomas Slunecko
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna
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Robin G, Brown E, Davis CA, Bird L, Wilson L, Halperin R, Brundage M, Croke J, Harper C, Giuliani M, Caissie A. Patient Engagement: an Assessment of Canadian Radiotherapy Programs' Current Practices, Perceived Barriers, and Facilitators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1834-1841. [PMID: 34518991 DOI: 10.1007/s13187-021-02049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Patient engagement and education have been mandated across Canadian radiation oncology programs (ROP). Guidance documents include the 2014 Canadian Association of Radiation Oncology (CARO) Radiation Therapy Patient Charter, the 2016 Canadian Partnership for Quality Radiotherapy (CPQR) Patient Engagement Guidelines (PEG) for Canadian Radiation Treatment Programs, and Accreditation Canada's 2017 refresh of Cancer Care Standards. Since little is known regarding uptake of these guidance statements, Canadian ROP were surveyed to assess current patient engagement and education practices. An e-survey was sent to Canadian ROP (n = 44). The survey focused on awareness and uptake of the CARO Patient Charter, CPQR PEG, and patient education practices. Survey development was guided by these documents and expert consensus, including CARO's Quality and Standards Patient Education/Engagement working group. Many (71%) responding ROP were familiar with the CARO Patient Charter, while 24% reported use. More than half (53%) of ROP were aware of the CPQR PEG, but approximately third (37%) had previously completed a self-audit. Most (88%) ROP view a pan-Canadian, evidence-based approach to educational materials beneficial and feasible (80%), with the majority (89%) willing to share their best practices across the radiotherapy community. Patient engagement and education are nationally mandated and supported by guidance documents. However, gaps have been identified across ROP for awareness and use of available tools, as well as uptake of their processes critical to quality of care. Understanding current practices will inform CPQR/CARO-supported pan-Canadian initiatives to optimize uptake, including development of CPQR Patient Education Guidance for Canadian Radiation Treatment Programs.
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Affiliation(s)
- Gabrielle Robin
- Dalhousie University, Halifax, NB & NS, Canada.
- CARO Quality and Standards Working Group, Markham, ON, Canada.
| | - Erika Brown
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Carol-Anne Davis
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Louise Bird
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Lianne Wilson
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Ross Halperin
- CARO Quality and Standards Working Group, Markham, ON, Canada
- BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Brundage
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Jennifer Croke
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Cody Harper
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
| | - Meredith Giuliani
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Amanda Caissie
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
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Hsiao CY, Wu JC, Lin PC, Yang PY, Liao F, Guo SL, Hou WH. Effectiveness of interprofessional shared decision-making training: A mixed-method study. PATIENT EDUCATION AND COUNSELING 2022; 105:3287-3297. [PMID: 35927112 DOI: 10.1016/j.pec.2022.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study evaluated the learning effects and examined the participants' perceptions of an interprofessional shared decision-making (IP-SDM) training program. METHODS This mixed-method study used a quasi-experimental pretest-posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb's experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules. RESULTS A total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners' attitude, knowledge, skills, and teamwork. CONCLUSION This IP-SDM training program improved multidisciplinary healthcare personnel's competency, self-efficacy, and intention to engage in IP-SDM. PRACTICE IMPLICATIONS Applying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel's knowledge, attitude, skills, and teamwork in IP-SDM.
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Affiliation(s)
- Chih-Yin Hsiao
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan; Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Pi-Chu Lin
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing & Graduate Institute of Nursing, Asia University, Taichung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Pang-Yuan Yang
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Faith Liao
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan; Department of Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Hsuan Hou
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation & Geriatrics and Gerontology, Taipei Medical University Hospital, Taipei, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Baghus A, Giroldi E, Muris J, Stiggelbout A, van de Pol M, Timmerman A, van der Weijden T. Identifying Entrustable Professional Activities for Shared Decision Making in Postgraduate Medical Education: A National Delphi Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:126-133. [PMID: 32739926 PMCID: PMC7769188 DOI: 10.1097/acm.0000000000003618] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Although shared decision making (SDM) is considered the preferred approach in medical decision making, it is currently not routinely used in clinical practice. To bridge the transfer gap between SDM training and application, the authors aimed to reach consensus on entrustable professional activities (EPAs) for SDM and associated behavioral indicators as a framework to support self-directed learning during postgraduate medical education. METHOD Using existing literature on SDM frameworks and competencies; input from an interview study with 17 Dutch experts in SDM, doctor-patient communication, and medical education; and a national SDM expert meeting as a starting point, in 2017, the authors conducted a modified online Delphi study with a multidisciplinary Dutch panel of 32 experts in SDM and medical education. RESULTS After 3 Delphi rounds, consensus was reached on 4 EPAs-(1) the resident discusses the desirability of SDM with the patient, (2) the resident discusses the options for management with the patient, (3) the resident explores the patient's preferences and deliberations, and (4) the resident takes a well-argued decision together with the patient. Consensus was also reached on 18 associated behavioral indicators. Of the 32 experts, 30 (94%) agreed on this list of SDM EPAs and behavioral indicators. CONCLUSIONS The authors succeeded in developing EPAs and associated behavioral indicators for SDM for postgraduate medical education to improve the quality of SDM training and the application of SDM in clinical practice. These EPAs are characterized as process EPAs for SDM in contrast with content EPAs related to diverse medical complaints. A next step is the implementation of the SDM EPAs in existing competency-based workplace curricula.
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Affiliation(s)
- Anouk Baghus
- A. Baghus is a PhD student and resident, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-6481-9256
| | - Esther Giroldi
- E. Giroldi is assistant professor, Department of Family Medicine, Care and Public Health Research Institute and Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0003-3254-4849
| | - Jean Muris
- J. Muris is professor, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-8780-476X
| | - Anne Stiggelbout
- A. Stiggelbout is professor, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; ORCID: http://orcid.org/0000-0002-6293-4509
| | - Marjolein van de Pol
- M. van de Pol is associate professor, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; ORCID: http://orcid.org/0000-0002-0977-7954
| | - Angelique Timmerman
- A. Timmerman is assistant professor, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-8114-8802
| | - Trudy van der Weijden
- T. van der Weijden is professor, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-7469-3781
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Singh Ospina N, Toloza FJK, Barrera F, Bylund CL, Erwin PJ, Montori V. Educational programs to teach shared decision making to medical trainees: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1082-1094. [PMID: 32005556 DOI: 10.1016/j.pec.2019.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/06/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is a process of collaboration between patients and clinicians. An increasing number of educational programs to teach SDM have been developed. We aimed to summarize and evaluate the body of evidence assessing the outcomes of these programs. METHODS We conducted a systematic review of studies that aimed to teach SDM to medical trainees. Reviewers worked independently and in duplicate to select studies, extract data and evaluate the risk of bias. RESULTS Eighteen studies were included. Most studies focused on residents/fellows (61 %) and combined a didactic component with a practical experience (50 % used a standardized patient). Overall, participants reported satisfaction with the courses. The effects on knowledge, attitudes/confidence and comfort with SDM were small; no clear improvement on SDM skills was noted. Evaluation of clinical behavior and outcomes was limited (3/18 studies). Studies had moderate risk of bias. CONCLUSION Very low quality evidence suggests that educational programs for teaching SDM to medical trainees are viewed as satisfactory and have a small impact on knowledge and comfort with SDM. Their impact on clinical skills, behaviors and patient outcomes is less clear. PRACTICAL IMPLICATIONS Integration of formal and systematic outcomes evaluation (effects on behavior/clinical practice) should be part of future programs.
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Affiliation(s)
| | - Freddy J K Toloza
- Division of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, US; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US
| | | | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, US
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US; Division of Endocrinology, Mayo Clinic, Rochester, US
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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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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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Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, Lindenauer PK, Mazor KM. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education. J Grad Med Educ 2018; 10:43-50. [PMID: 29467972 PMCID: PMC5821016 DOI: 10.4300/jgme-d-17-00318.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/10/2017] [Accepted: 09/24/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. OBJECTIVE We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. METHODS We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. RESULTS Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. CONCLUSIONS A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
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Berman AT, Rosenthal SA, Moghanaki D, Woodhouse KD, Movsas B, Vapiwala N. Focusing on the "Person" in Personalized Medicine: The Future of Patient-Centered Care in Radiation Oncology. J Am Coll Radiol 2017; 13:1571-1578. [PMID: 27888944 DOI: 10.1016/j.jacr.2016.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022]
Abstract
Numerous efforts in radiation oncology aim to improve the value of clinical care. To evaluate the success of these efforts, outcome measures must be well defined and incorporate the beliefs of the patients they affect. These outcomes have historically centered on rates of tumor control, overall survival, and adverse events as perceived and reported by providers. However, the future of patient-centered care in radiation oncology is increasingly focusing on the "person" in the population and the individual in the studies to more closely reflect the ideals of personalized medicine. Formally known as patient-centered outcomes, this metric encompasses parameters of patient satisfaction, engagement, and treatment compliance. Evaluations that investigate the safety and efficacy of treatments are increasingly soliciting participation from patients within a model of shared decision making that improves patients' knowledge, satisfaction, physical and emotional well-being, and trust in providers. Modern clinical trials that embrace this approach may even focus on patient-reported outcomes as the primary end point, as opposed to time-honored physician-reported events. The authors explore the growing role of patient-centered care, the incorporation of shared decision making, and the relevant body of existing and developing literature on this topic in radiation oncology. The authors report recent discoveries from this area of study and describe how they can not only support high-quality, high-value patient care but also enhance recruitment to clinical oncology trials, both of which are challenging to achieve in today's relatively resource-strapped environment.
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Affiliation(s)
- Abigail T Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Seth A Rosenthal
- Sutter Medical Group and Sutter Cancer Center, Sacramento, California
| | | | - Kristina D Woodhouse
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Tamirisa NP, Goodwin JS, Kandalam A, Linder SK, Weller S, Turrubiate S, Silva C, Riall TS. Patient and physician views of shared decision making in cancer. Health Expect 2017; 20:1248-1253. [PMID: 28464430 PMCID: PMC5689235 DOI: 10.1111/hex.12564] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Engaging patients in shared decision making involves patient knowledge of treatment options and physician elicitation of patient preferences. OBJECTIVE Our aim was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care. DESIGN Patients and physicians were asked open-ended questions regarding their perceptions of shared decision making throughout their cancer care. Transcripts of interviews were coded and analysed for shared decision-making themes. SETTING AND PARTICIPANTS At an academic medical centre, 20 cancer patients with a range of cancer diagnoses, stages of cancer and time from diagnosis, and eight physicians involved in cancer care were individually interviewed. DISCUSSION AND CONCLUSIONS Most physicians reported providing patients with written information. However, most patients reported that written information was too detailed and felt that the physicians did not assess the level of information they wished to receive. Most patients wanted to play an active role in the treatment decision, but also wanted the physician's recommendation, such as what their physician would choose for him/herself or a family member in a similar situation. While physicians stated that they incorporated patient autonomy in decision making, most provided data without making treatment recommendations in the format preferred by most patients. We identified several communication gaps in cancer care. While patients want to be involved in the decision-making process, they also want physicians to provide evidence-based recommendations in the context of their individual preferences. However, physicians often are reluctant to provide a recommendation that will bias the patient.
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Affiliation(s)
- Nina P Tamirisa
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.,The University of California, San Francisco-East Bay, Oakland, CA, USA
| | - James S Goodwin
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Arti Kandalam
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Suzanne K Linder
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Susan Weller
- Department of Family Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Stella Turrubiate
- Department of Oncology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor S Riall
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
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Paraskeva N, Clarke A, Grover R, Hamilton S, Withey S, Harcourt D. Facilitating shared decision-making with breast augmentation patients: Acceptability of the PEGASUS intervention. J Plast Reconstr Aesthet Surg 2016; 70:203-208. [PMID: 28010934 DOI: 10.1016/j.bjps.2016.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/14/2016] [Accepted: 11/18/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND PEGASUS is an intervention to facilitate shared decision-making by helping prospective patients consider their expectations of surgery, so that surgeons have a clear understanding of their individual goals. To date, shared decision-making interventions within aesthetic surgery are lacking. The present mixed methods study therefore explored the acceptability of implementing PEGASUS into routine private practice with breast augmentation patients and aesthetic providers. METHOD Seventeen women presenting for breast augmentation surgery from three practices received the PEGASUS intervention pre-operatively and completed a process evaluation post-operatively. Semi-structured interviews exploring 3 aesthetic providers' experiences of using PEGASUS were subjected to a thematic analysis, whilst a content analysis was conducted on the 77 goals identified by patients. RESULTS The majority of patients reported that the PEGASUS intervention was relevant, helpful and useful, and they felt comfortable during it. Qualitatively, patients and aesthetic providers found that PEGASUS enabled them to reflect on and discuss about their expectations from surgery. Aesthetic providers discussed some of the issues and barriers associated with implementing PEGASUS in routine private practice, factors that must be considered prior to further evaluation. CONCLUSION This study provides preliminary support for the acceptability of PEGASUS to breast augmentation patients and to aesthetic providers working in the private sector.
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Affiliation(s)
- Nicole Paraskeva
- Centre for Appearance Research, Department of Health & Social Sciences, Faculty of Health & Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Alex Clarke
- Centre for Appearance Research, Department of Health & Social Sciences, Faculty of Health & Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
| | - Rajiv Grover
- Harley Street Practice, 144 Harley St, Marylebone, London W1G 7LE, UK
| | - Stephen Hamilton
- Hospital of St John and St Elizabeth, 60 Grove End Road, London, NW8 9NH, UK
| | - Simon Withey
- Hospital of St John and St Elizabeth, 60 Grove End Road, London, NW8 9NH, UK
| | - Diana Harcourt
- Centre for Appearance Research, Department of Health & Social Sciences, Faculty of Health & Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
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14
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Stacey D, Taljaard M, Smylie J, Boland L, Breau RH, Carley M, Jana K, Peckford L, Blackmore T, Waldie M, Wu RC, Legare F. Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation. Implement Sci 2016; 11:87. [PMID: 27368830 PMCID: PMC4930601 DOI: 10.1186/s13012-016-0451-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men’s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use. Methods/design Guided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men’s decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts. Discussion Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men’s active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0451-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Jennifer Smylie
- Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Laura Boland
- Population Health, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Rodney H Breau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Surgery, Division of Urology, University of Ottawa, 501 Smyth Rd, Ottawa, K1H 8L6, Canada
| | - Meg Carley
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Kunal Jana
- Department of Surgery, Division of Urology, 537-750 Spadina Cr. E., Saskatoon, S7K 3H3, Canada
| | | | - Terry Blackmore
- Quality and Continuous Improvement, Acute and Emergency Services Branch, Saskatchewan Ministry of Health, Regina, Canada
| | - Marian Waldie
- Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Robert Chi Wu
- Postgraduate Medical Education, University of Ottawa, Ottawa, Canada
| | - France Legare
- Research Centre CHU de Quebec-Universite Laval, Quebec, Canada
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15
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Giguere AM, Labrecque M, Légaré F, Grad R, Cauchon M, Greenway M, Haynes RB, Pluye P, Syed I, Banerjee D, Carmichael PH, Martin M. Feasibility of a randomized controlled trial to evaluate the impact of decision boxes on shared decision-making processes. BMC Med Inform Decis Mak 2015; 15:13. [PMID: 25880757 PMCID: PMC4350632 DOI: 10.1186/s12911-015-0134-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 01/27/2015] [Indexed: 12/04/2022] Open
Abstract
Background Decision boxes (DBoxes) are two-page evidence summaries to prepare clinicians for shared decision making (SDM). We sought to assess the feasibility of a clustered Randomized Controlled Trial (RCT) to evaluate their impact. Methods A convenience sample of clinicians (nurses, physicians and residents) from six primary healthcare clinics who received eight DBoxes and rated their interest in the topic and satisfaction. After consultations, their patients rated their involvement in decision-making processes (SDM-Q-9 instrument). We measured clinic and clinician recruitment rates, questionnaire completion rates, patient eligibility rates, and estimated the RCT needed sample size. Results Among the 20 family medicine clinics invited to participate in this study, four agreed to participate, giving an overall recruitment rate of 20%. Of 148 clinicians invited to the study, 93 participated (63%). Clinicians rated an interest in the topics ranging 6.4-8.2 out of 10 (with 10 highest) and a satisfaction with DBoxes of 4 or 5 out of 5 (with 5 highest) for 81% DBoxes. For the future RCT, we estimated that a sample size of 320 patients would allow detecting a 9% mean difference in the SDM-Q-9 ratings between our two arms (0.02 ICC; 0.05 significance level; 80% power). Conclusions Clinicians’ recruitment and questionnaire completion rates support the feasibility of the planned RCT. The level of interest of participants for the DBox topics, and their level of satisfaction with the Dboxes demonstrate the acceptability of the intervention. Processes to recruit clinics and patients should be optimized. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0134-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anik Mc Giguere
- Research Centre for Excellence in Aging, CHU de Quebec, Saint-Sacrement Hospital, 1050 chemin Ste-Foy, Québec, Québec, G1S 4L8, Canada. .,Department of Family and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, G1V 0A6, Canada.
| | - Michel Labrecque
- Department of Family and Emergency Medicine, Research Center of the CHU de Quebec, Saint-Francois d'Assise Hospital, Laval University, 10 rue de l'Espinay, D6-730, Quebec City, QC, G1L 3L5, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Research Center of the CHU de Quebec, Saint-Francois d'Assise Hospital, Laval University, 10 rue de l'Espinay, D6-730, Quebec City, QC, G1L 3L5, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Herzl Family Practice Centre, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada
| | - Michel Cauchon
- Department of Family and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Matthew Greenway
- Department of Family Medicine, McMaster University, 118 Lake Street, St. Catharines, ON, Canada
| | - R Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, L8S 4K1, Canada.,Department of Medicine, DeGroote School of Medicine, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, L8S 4K1, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, Montreal, QC, H3S 1Z1, Canada
| | - Iqra Syed
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, L8S 4K1, Canada
| | - Debi Banerjee
- The University of Toronto, Faculty of Medicine, 1 King's College Circle, Medical Sciences Building (Rm. 2109), Toronto, ON, M5S-1A8, Canada
| | - Pierre-Hugues Carmichael
- Research Centre for Excellence in Aging, CHU de Quebec, Saint-Sacrement Hospital, 1050 chemin Ste-Foy, Québec, Québec, G1S 4L8, Canada
| | - Mélanie Martin
- Research Centre for Excellence in Aging, CHU de Quebec, Saint-Sacrement Hospital, 1050 chemin Ste-Foy, Québec, Québec, G1S 4L8, Canada.,Department of Family and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, G1V 0A6, Canada
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Kane HL, Halpern MT, Squiers LB, Treiman KA, McCormack LA. Implementing and evaluating shared decision making in oncology practice. CA Cancer J Clin 2014; 64:377-88. [PMID: 25200391 DOI: 10.3322/caac.21245] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice.
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Affiliation(s)
- Heather L Kane
- Health Services Analyst, Primary Prevention Research and Evaluation Program, RTI International, Research Triangle Park, North Carolina
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Volk RJ, Shokar NK, Leal VB, Bulik RJ, Linder SK, Mullen PD, Wexler RM, Shokar GS. Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians. BMC Med Inform Decis Mak 2014; 14:95. [PMID: 25361614 PMCID: PMC4283132 DOI: 10.1186/1472-6947-14-95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/13/2014] [Indexed: 11/16/2022] Open
Abstract
Background Although research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians. Methods A three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians’ general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online. Results Seventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient’s preferred role in making the decision (62.5% very confident) and exploring a patient’s values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future. Conclusions A comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients’ desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies. Electronic supplementary material The online version of this article (doi:10.1186/1472-6947-14-95) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert J Volk
- Department of Health Services Research, Unit 1444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Ferron Parayre A, Labrecque M, Rousseau M, Turcotte S, Légaré F. Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients. Med Decis Making 2013; 34:54-62. [PMID: 23776141 DOI: 10.1177/0272989x13491463] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to determine the psychometric properties of SURE, a 4-item checklist designed to screen for clinically significant decisional conflict in clinical practice. METHODS This study was a secondary analysis of a clustered randomized trial assessing the effect of DECISION+2, a 2-hour online tutorial followed by a 2-hour interactive workshop on shared decision making, on decisions to use antibiotics for acute respiratory infections. Patients completed SURE and also the Decisional Conflict Scale (DCS), as the gold standard, after consultation. We evaluated internal consistency of SURE using the Kuder-Richardson 20 coefficient (KR-20). We compared DCS and SURE scores using the Spearman correlation coefficient. We assessed sensitivity and specificity of SURE scores (cut-off score ≤3 out of 4) by identifying patients with and without clinically significant decisional conflict (DCS score >37.5 on a scale of 0-100). RESULTS Of the 712 patients recruited during the trial, 654 completed both tools. SURE scores showed adequate internal consistency (KR-20 coefficient of 0.7). There was a significant correlation between DCS and SURE scores (Spearman's ρ = -0.45, P < 0.0001). The prevalence of clinically significant decisional conflict as estimated by the DCS was 5.2% (95% CI 3.7-7.3). Sensitivity and specificity of SURE ≤3 were 94.1% (95% CI 78.9-99.0) and 89.8% (95% CI 87.1-92.0), respectively. CONCLUSIONS SURE shows adequate psychometric properties in a primary care population with a low prevalence of clinically significant decisional conflict. SURE has the potential to be a useful screening tool for practitioners, responding to the growing need for detecting clinically significant decisional conflict in patients.
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Affiliation(s)
- Audrey Ferron Parayre
- Research Centre of the Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer and Health Technology Assessment Research Group (AFP, ML, ST, FL).,Faculty of Medicine, Universite´ Laval, Quebec, QC, Canada (AFP, ML, FL)
| | - Michel Labrecque
- Research Centre of the Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer and Health Technology Assessment Research Group (AFP, ML, ST, FL).,Faculty of Medicine, Universite´ Laval, Quebec, QC, Canada (AFP, ML, FL)
| | - Michel Rousseau
- Department of Psychoeducation, Universite´ du Que´-bec a` Trois-Rivie` res, Quebec, QC, Canada (MR)
| | - Stéphane Turcotte
- Research Centre of the Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer and Health Technology Assessment Research Group (AFP, ML, ST, FL)
| | - France Légaré
- Research Centre of the Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer and Health Technology Assessment Research Group (AFP, ML, ST, FL).,Faculty of Medicine, Universite´ Laval, Quebec, QC, Canada (AFP, ML, FL)
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Légaré F, Stacey D, Brière N, Fraser K, Desroches S, Dumont S, Sales A, Puma C, Aubé D. Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: a mixed methods study. J Interprof Care 2013; 27:214-22. [PMID: 23394265 PMCID: PMC3665231 DOI: 10.3109/13561820.2013.763777] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In an interprofessional approach to shared decision-making (IP-SDM), an interprofessional team collaborates in identifying best options and helps patients determine their preferences, enabling them to take more control over the treatment plan. However, little is known about fostering IP-SDM in Canada's healthcare system. Therefore, we sought to evaluate health professionals' intentions to engage in IP-SDM in home care and explore the factors associated with this intention. A total of 272 eligible home care providers completed a questionnaire based on the theory of planned behavior. Eight managers and one healthcare team caring for the frail elderly were interviewed about possible barriers and facilitators. Analysis involved descriptive statistics and multivariate analysis of quantitative data and content analysis of qualitative data. On a scale of − 3 (strongly disagree) to +3 (strongly agree), the mean intention to engage in IP-SDM was positive (1.42 ± 1.39). The intention was influenced by the following theory-based determinants (R2 = 57%; p ≤ 0.002), i.e. cognitive attitude (p < 0.001) subjective norm (p < 0.0001) and perceived behavioral control (p < 0.0001), with variations depending on the type of provider. Barriers included lack of time, poor team cohesion and high staff turnover. Facilitators included team cohesion and shared tools. Future programs implementing IP-SDM could address these barriers and facilitators.
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Affiliation(s)
- France Légaré
- Family Medicine and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada.
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