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Xiao L, Huang C, Bai Y, Ding J. Shared decision-making training embedded in undergraduate and postgraduate medical education: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 123:108186. [PMID: 38331626 DOI: 10.1016/j.pec.2024.108186] [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: 07/18/2023] [Revised: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This review mapped the published literature on shared decision-making (SDM) training embedded in undergraduate and/or postgraduate medical education. METHODS We conducted a scoping review following the framework proposed by Arksey and O'Malley. We searched ten databases and Google Scholar and manual searched reference list in included articles. Two researchers independently screened articles and extracted data. A narrative synthesis was used for data analysis. RESULTS This review identified 27 studies describing 25 unique SDM programs. Most programs integrated SDM training in undergraduate education, encompassing an overview of SDM theories and enhancing skills through role-plays. The programs duration ranged from one to 24 h. Overall, they improved students' SDM knowledge, attitude, confidence and skills, but the impact for students on patients is unclear due to lack of long-term follow-up. CONCLUSION The current SDM programs appear to be effectiveness in achieving short-term SDM-related outcomes. These programs were heterogeneous in their content, duration and delivery. Future research should concentrate on exploring the long-term impact of SDM programs, particularly students' application of SDM practices and patient outcomes. PRACTICE IMPLICATIONS Embedding SDM training in undergraduate and/or postgraduate medical education may be a practical and effective solution for current barriers to the widespread adoption of SDM.
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Affiliation(s)
- Lin Xiao
- School of nursing, Southern Medical University, Guangzhou, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yang Bai
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China.
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Ankersmid JW, Engelhardt EG, Lansink Rotgerink FK, The R, Strobbe LJA, Drossaert CHC, Siesling S, van Uden-Kraan CF. Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach. Cancers (Basel) 2024; 16:1390. [PMID: 38611068 PMCID: PMC11010914 DOI: 10.3390/cancers16071390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. METHODS Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. RESULTS The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. DISCUSSION When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.
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Affiliation(s)
- Jet W. Ankersmid
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Santeon, 3584 AA Utrecht, The Netherlands; (E.G.E.)
| | | | | | - Regina The
- ZorgKeuzeLab, 2611 BN Delft, The Netherlands
| | - Luc J. A. Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Constance H. C. Drossaert
- Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands
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Ben-Moshe N, Levinstein BA, Livengood J. Probability and informed consent. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:545-566. [PMID: 37552358 DOI: 10.1007/s11017-023-09636-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023]
Abstract
In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues.
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Affiliation(s)
- Nir Ben-Moshe
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA.
| | - Benjamin A Levinstein
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA
| | - Jonathan Livengood
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA
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Rosen JE, Agrawal N, Flum DR, Liao JM. Verbal Descriptions of the Probability of Treatment Complications Lead to High Variability in Risk Perceptions: A Survey Study. Ann Surg 2023; 277:e766-e771. [PMID: 35129504 PMCID: PMC9035471 DOI: 10.1097/sla.0000000000005255] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception. BACKGROUND Surgeons must communicate the probability of treatment complications to patients, and how risks are communicated may impact the accuracy and variability in patient risk perceptions and ultimately their decision making. METHODS A series of online surveys of American adults communicated the probability of complications associated with surgical or antibiotic treatment of acute appendicitis. Probability was communicated with verbal descriptors (eg, "uncommon"), point estimates (eg, "3% risk"), or risk ranges (eg, "1% to 5%"). Respondents then estimated the probability of a complication for a "typical patient with appendicitis." The Fligner-Killeen test of homogeneity of variance was used to compare the variability in respondent risk estimates based on the method of probability communication. RESULTS Among 296 respondents, variance in probability estimates was significantly higher when verbal descriptions were used compared to point estimates ( P < 0.001) or risk ranges ( P < 0.001). Identical verbal descriptors produced meaningfully different risk estimates depending on the complication being described. For example, "common" was perceived as a 45.6% for surgical site infection but 61.7% for antibiotic-associated diarrhea. CONCLUSION Verbal probability descriptors are associated with widely varying and inaccurate perceptions about treatment risks. Surgeons should consider alternative ways to communicate probability during informed consent and shared decision-making discussions.
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Affiliation(s)
- Joshua E. Rosen
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
- Decision Science Group, University of Washington, Seattle, WA
| | - Nidhi Agrawal
- Decision Science Group, University of Washington, Seattle, WA
- Foster School of Business, University of Washington, Seattle, WA
| | - David R. Flum
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
- Decision Science Group, University of Washington, Seattle, WA
| | - Joshua M. Liao
- Decision Science Group, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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Numeracy levels influence shared decision-making and surgical outcomes: A scoping review of the literature. Am J Surg 2023; 225:967-974. [PMID: 36623965 DOI: 10.1016/j.amjsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Health literacy has been widely studied with regard to medical decision-making and health care access, however research regarding numeracy - the ability to comprehend and attach meaning to numbers - is more limited. METHODS A scoping review following PRISMA guidelines was conducted. We screened 132 abstracts and 12 studies were included in the analysis. RESULTS Surgical population numeracy ranged from 47 to 86.1%. We found heterogeneity in the scales used to measure numeracy and the cutoff values used to define adequate numeracy. Low numeracy was shown to influence the accuracy of patients' responses to quality of life measures used to determine surgical outcomes and was associated with patient overestimation of pre-operative risk. Adequate numeracy was correlated with improved outcomes 2-4 years after bariatric surgery. CONCLUSIONS Patient numeracy is generally poor and has important implications for pre-operative risk understanding, accuracy of health measurement tools and long-term surgical outcomes.
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Crew KD, Bhatkhande G, Silverman T, Amenta J, Jones T, McGuinness JE, Mata J, Guzman A, He T, Dimond J, Tsai WY, Kukafka R. Patient and Provider Web-Based Decision Support for Breast Cancer Chemoprevention: A Randomized Controlled Trial. Cancer Prev Res (Phila) 2022; 15:689-700. [PMID: 35679576 PMCID: PMC9532364 DOI: 10.1158/1940-6207.capr-22-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
Significant underutilization of breast cancer chemoprevention remains, despite guidelines stating that physicians should recommend chemoprevention with antiestrogen therapy to high-risk women. We randomized women, ages 35 to 75 years, who met high-risk criteria for breast cancer, without a personal history of breast cancer or prior chemoprevention use, to standard educational materials alone or combined with a web-based decision aid. All healthcare providers, including primary care providers and breast specialists, were given access to a web-based decision support tool. The primary endpoint was chemoprevention uptake at 6 months. Secondary outcomes included decision antecedents (perceived breast cancer risk/worry, chemoprevention knowledge, self-efficacy) and decision quality (decision conflict, chemoprevention informed choice) based upon patient surveys administered at baseline, 1 and 6 months after randomization. Among 282 evaluable high-risk women enrolled from November 2016 to March 2020, mean age was 57 years (SD, 9.9) and mean 5-year invasive breast cancer risk was 2.98% (SD, 1.42). There was no significant difference in chemoprevention uptake at 6 months between the intervention and control groups (2.1% vs. 3.5%). Comparing the intervention and control arms at 1 month, there were significant differences among high-risk women in accurate breast cancer risk perceptions (56% vs. 39%, P = 0.017), adequate chemoprevention knowledge (49% vs. 27%, P < 0.001), mean decision conflict (34.0 vs. 47.0, P < 0.001), and informed choice (41% vs. 23%, P = 0.003). These differences were no longer significant at 6 months. Although our decision support tools did not result in a significant increase in chemoprevention uptake, we did observe improvements in decision antecedents and decision quality measures. PREVENTION RELEVANCE In this randomized controlled trial of decision support for 300 high-risk women and 50 healthcare providers, we did not observe a significant increase in chemoprevention uptake, which remained low at under 5%. However, these decision support tools may increase knowledge and informed choice about breast cancer chemoprevention.
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Affiliation(s)
- Katherine D. Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Gauri Bhatkhande
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Thomas Silverman
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Jacquelyn Amenta
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Tarsha Jones
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL
| | - Julia E. McGuinness
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Jennie Mata
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Ashlee Guzman
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Ting He
- Department of Biomedical Informatics and Data Sciences, Johns Hopkins University, Baltimore, MD
| | | | - Wei-Yann Tsai
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Rita Kukafka
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
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Benson S, Schmidt K, Kleine-Borgmann J, Herbstreit S, Schedlowski M, Hollinderbäumer A. Can positive expectations help to improve the learning of risk literacy? A cluster-randomized study in undergraduate medical students. BMC MEDICAL EDUCATION 2022; 22:416. [PMID: 35641950 PMCID: PMC9158291 DOI: 10.1186/s12909-022-03498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Risk literacy, i.e., the ability to calculate and apply risk parameters, represents a key competence for risk communication and medical decision making. However, risk literacy is reportedly low in medical students. The successful acquisition of statistical competencies is often difficult, and can be hampered by emotional learning obstacles, calling for interventions to support learning. In this cluster-randomized study, we aimed to translate findings from placebo research to medical education. Specifically, we tested if the acquisition of risk literacy during a seminar unit can be facilitated by positive expectations, induced by a positive and non-threatening framing of the content and learning goals. METHODS The study took place during a mandatory 2.5-h seminar on "risk literacy" for 2nd year medical students. The seminar teaches both statistical knowledge and its application in patient communication. To test the effects of expectations on risk literacy acquisition, the (otherwise identical) seminar was framed either as "communication training" (positive framing condition) or "statistics seminar" (negative framing condition). All N = 200 students of the semester were invited to participate, and cluster-randomized to the positive or negative framing condition (4 seminar groups each condition). Risk literacy was assessed with the "Quick Risk Test" (QRT) at the beginning and end of the seminar, along with statistics anxiety and subjective learning success using questionnaires. RESULTS Data from N = 192 students were included. At the end of the seminar, risk literacy was increased in both framing conditions, with a significantly greater increase in QRT scores in the positive framing condition. Statistics anxiety was significantly decreased in both framing conditions, with no evidence of group differences. Subjective learning success was overall high and comparable between groups. CONCLUSIONS Supporting our hypothesis, positive framing led to a significantly greater increase in risk literacy (i.e., in QRT scores). Our data offer first support that positive framing of learning goals may help to facilitate the acquisition of statistical knowledge. Expectation-orientated interventions may thus offer a feasible tool to optimize learning settings and framing of learning objectives in medical statistics courses.
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Affiliation(s)
- Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
- Institute of Medical Education, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
| | - Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephanie Herbstreit
- Department of Orthopedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Anke Hollinderbäumer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, University of Mainz, Mainz, Germany
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Groene OR, Bergelt C, Ehrhardt M. How good are medical students at communicating risk? An implementation study at three German medical schools. PATIENT EDUCATION AND COUNSELING 2022; 105:128-135. [PMID: 34020838 DOI: 10.1016/j.pec.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/01/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the objective and subjective risk communication skills of medical students in three universities in Germany METHODS: We developed a risk communication skills Objective Structured Clinical Examination (OSCE) station and implemented it in three medical schools in Germany. 596 students contributed data to a risk communication checklist and a risk communication self-assessment. Multiple linear regression models were used to identify factors associated with the risk communication OSCE performance. RESULTS Participants in our study achieved on average 73.5% of the total risk communication skills score, which did not differ between locations (F(2-595) = 1.96; p = 0.142). The mean objective performance of students who assessed their skills as poor was significantly worse than the performance of students who assessed their skills as good (t(520) = -5.01, p < 0.001). The risk communication skills score was associated with native language but not with gender nor General Point Average (p < 0.001). CONCLUSIONS Medical students demonstrated acceptable risk communication skills scores and were able to self-assess their performance. However, selected communication techniques should be re-emphasised in the undergraduate medical curriculum. PRACTICE IMPLICATIONS Our research identified shortcomings in particular subgroups that can be addressed through tailored curriculum interventions.
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Affiliation(s)
- Oana R Groene
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Germany.
| | - Corinna Bergelt
- Corinna Bergelt, Institute of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Maren Ehrhardt
- Maren Ehrhardt, Institute of General Practice, University Medical Center Hamburg-Eppendorf, Germany
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Hoffmann TC, Del Mar C, Santhirapala R, Freeman A. Teaching clinicians shared decision making and risk communication online: an evaluation study. BMJ Evid Based Med 2021; 26:253. [PMID: 32962972 PMCID: PMC8479734 DOI: 10.1136/bmjebm-2020-111521] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties. DESIGN Comparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication. SETTING Online and open to all specialties and levels of clinical experience, including students. PARTICIPANTS The course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study. INTERVENTION The self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK's National Health Service e-learning platform. MAIN OUTCOME MEASURES Pre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool; total score range 10-50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked. RESULTS Of 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants' mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p<0.0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p<0.0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions. CONCLUSIONS This online, free e-learning course was successful in increasing participants' confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians' numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ramai Santhirapala
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Freeman
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
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Lee C, Hall K, Anakin M, Pinnock R. Towards a new understanding of uncertainty in medical education. J Eval Clin Pract 2021; 27:1194-1204. [PMID: 33089607 DOI: 10.1111/jep.13503] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Uncertainty is a complex and constant phenomenon in clinical practice. How medical students recognize and respond to uncertainty impacts on their well-being, career choices, and attitudes towards patients. It has been suggested that curricula should do more to prepare medical students for an uncertain world. In order to teach medical students about uncertainty, we need to understand how uncertainty has been conceptualized in the literature to date. The aim of this article is to explore existing models of uncertainty and to develop a framework of clinical uncertainty to aid medical education. METHOD A scoping literature review was performed to identify conceptual models of uncertainty in healthcare. Content and inductive analyses were performed to explore three dimensions of clinical uncertainty: sources of uncertainty, subjective influencers and responses to uncertainty. RESULTS Nine hundred one references were identified using our search strategy, of which, 24 met our inclusion criteria. It was possible to classify these conceptual models using one or more of three dimensions of uncertainty; sources, subjective influencers, and responses. Exploration and further classification of these dimensions led to the development of a framework of uncertainty for medical education. CONCLUSION The developed framework of clinical uncertainty highlights sources, subjective influencers, responses to uncertainty, and the dynamic relationship among these elements. Our framework illustrates the different aspects of knowledge as a source of uncertainty and how to distinguish between those aspects. Our framework highlights the complexity of sources of uncertainty, especially when including uncertainty arising from relationships and systems. These sources can occur in combination. Our framework is also novel in how it describes the impact of influencers such as personal characteristics, experience, and affect on perceptions of and responses to uncertainty. This framework can be used by educators and curricula developers to help understand and teach about clinical uncertainty.
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Affiliation(s)
- Ciara Lee
- Department of General Practice and Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Katherine Hall
- Department of General Practice and Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Megan Anakin
- Education Unit, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ralph Pinnock
- Education Unit, Otago Medical School, University of Otago, Dunedin, New Zealand
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Moffett J, Hammond J, Murphy P, Pawlikowska T. The ubiquity of uncertainty: a scoping review on how undergraduate health professions' students engage with uncertainty. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:913-958. [PMID: 33646469 PMCID: PMC7917952 DOI: 10.1007/s10459-021-10028-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/11/2021] [Indexed: 05/30/2023]
Abstract
Although the evidence base around uncertainty and education has expanded in recent years, a lack of clarity around conceptual terms and a heterogeneity of study designs means that this landscape remains indistinct. This scoping review explores how undergraduate health professions' students learn to engage with uncertainty related to their academic practice. To our knowledge, this is the first scoping review which examines teaching and learning related to uncertainty across multiple health professions. The scoping review is underpinned by the five-stage framework of (Arksey and O'Malley in Scoping studies: Towards a methodological framework International Journal of Social Research Methodology 8(1) 19-32, 2005). We searched MEDLINE, Embase, PsychINFO, ISI Web of Science, and CINAHL and hand-searched selected health professions' education journals. The search strategy yielded a total of 5,017 articles, of which 97 were included in the final review. Four major themes were identified: "Learners' interactions with uncertainty"; "Factors that influence learner experiences"; "Educational outcomes"; and, "Teaching and learning approaches". Our findings highlight that uncertainty is a ubiquitous concern in health professions' education, with students experiencing different forms of uncertainty at many stages of their training. These experiences are influenced by both individual and system-related factors. Formal teaching strategies that directly support learning around uncertainty were infrequent, and included arts-based teaching, and clinical case presentations. Students also met with uncertainty indirectly through problem-based learning, clinical teaching, humanities teaching, simulation, team-based learning, small group learning, tactical games, online discussion of anatomy topics, and virtual patients. Reflection and reflective practice are also mentioned as strategies within the literature.
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Affiliation(s)
- Jenny Moffett
- RCSI Health Professions' Education Centre, 123 St Stephen's Green, Dublin, Ireland.
| | - Jennifer Hammond
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul Murphy
- RCSI Health Professions' Education Centre, 123 St Stephen's Green, Dublin, Ireland
| | - Teresa Pawlikowska
- RCSI Health Professions' Education Centre, 123 St Stephen's Green, Dublin, Ireland
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Moore HL, Farnworth A, Watson R, Giles K, Tomson D, Thomson RG. Inclusion of person-centred care in medical and nursing undergraduate curricula in the UK: Interviews and documentary analysis. PATIENT EDUCATION AND COUNSELING 2021; 104:877-886. [PMID: 33268231 DOI: 10.1016/j.pec.2020.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVE We aimed to understand how person-centred care (PCC) is represented in UK professional standards for undergraduate medical/nursing education and explored how these are reflected in programme provision. METHODS We identified PCC components in medical (GMC) and nursing (NMC) professional standards and university curricula documents provided. We also identified themes from interviews with high-level informants for medical/nursing undergraduate programmes using framework analysis. RESULTS The GMC appears to promote a more paternalistic model of care with discrete PCC components in specific sections and the NMC a more collaborative model with PCC distributed throughout. These differences persisted into education delivery. Medical educators perceived greater barriers to inclusion of PCC than nursing educators; however, both consistently identified cultural and organisational attributes. Clarity was lacking regarding PCC definition, how to teach/assess PCC, and competence expectations. CONCLUSION Development of a PCC skills competence framework would increase consistency and support teaching and assessment in undergraduate curricula. Further research to understand the perspectives of healthcare professionals involved in placements would help inform PCC teaching recommendations. PRACTICE IMPLICATIONS High-level support from senior HEI leaders; multi-disciplinary approaches to curricula development, teaching, and assessment; and greater inclusion of service users would ensure higher quality PCC education for undergraduate students.
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Affiliation(s)
- Heather L Moore
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK.
| | - Allison Farnworth
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rose Watson
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Giles
- Faculty of Health Sciences & Wellbeing, University of Sunderland, Sunderland, UK
| | - David Tomson
- Collingwood Surgery, Collingwood Health Group, North Shields, UK
| | - Richard G Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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13
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Baessler F, Zafar A, Ciprianidis A, Wagner FL, Klein SB, Schweizer S, Bartolovic M, Roesch-Ely D, Ditzen B, Nikendei C, Schultz JH. Analysis of risk communication teaching in psychosocial and other medical departments. MEDICAL EDUCATION ONLINE 2020; 25:1746014. [PMID: 32249706 PMCID: PMC7170276 DOI: 10.1080/10872981.2020.1746014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Aims: Teaching students about risk communication is an important aspect at medical schools given the growing importance of informed consent in healthcare. This observational study analyzes the quality of teaching content on risk communication and biostatistics at a medical school.Methods: Based on the concept of curriculum mapping, purpose-designed questionnaires were used via participant observers to record the frequency, characteristics and context of risk communication employed by lecturers during teaching sessions for one semester. The data was analyzed quantitatively and descriptively.Results: Teaching about risk communication was observed in 24.4% (n = 95 of 390) sessions. Prevalence varied significantly among different departments with dermatology having the highest rate (67.9%) but lesser in-depth teaching than medical psychology where risk communication concepts were discussed on a higher scale in 61.4% sessions. Relevant statistical values were not mentioned at all in 69% of these 95 sessions and clinical contexts were used rarely (55.8%). Supplementary teaching material was provided in 50.5% sessions while students asked questions in 18.9% sessions.Conclusions: Students are infrequently taught about communicating risks. When they are, the teaching does not include the mention of core biostatistics values nor does the teaching involve methods for demonstrating risk communication.
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Affiliation(s)
- Franziska Baessler
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
- CONTACT Franziska Baessler Department for General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, Heidelberg University Hospital,Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Ali Zafar
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Ciprianidis
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabienne Louise Wagner
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sonja Bettina Klein
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Marina Bartolovic
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
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A qualitative exploration of clinicians' strategies to communicate risks to patients in the complex reality of clinical practice. PLoS One 2020; 15:e0236751. [PMID: 32790675 PMCID: PMC7425874 DOI: 10.1371/journal.pone.0236751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk communication, situated in the model of shared decision making (SDM), is an essential element in daily clinical practice. The scientific literature makes a number of generic recommendations. Yet the application of risk communication remains a challenge in patient-clinician encounters. How clinicians actually communicate risk during consultations is not well understood. We aimed to explore the risk communication strategies used by clinicians and extract narratives and visualizations of those strategies to help inform medical education. METHODS In this qualitative descriptive study, we interviewed fifteen purposely sampled clinicians from several medical disciplines, who were familiar with the concept of SDM. Deductive and inductive content analysis was used during an iterative data collection and analyses process. RESULTS Our study identified various strategies reported to be used by clinicians to address the complexities of risk communication such as dealing with uncertainty. These included verbal, numerical and visual risk communication and framing. Clinicians were familiar with recommended risk formats such as natural frequencies and population pictograms. However, it became clear that clinicians' expertise and communication goals also play an important role in the risk talk. Clinicians try to lay a foundation for balanced decision-making and to incorporate patient preferences while faced with several challenges such as the dilemma of raising awareness but triggering anxiety or fan fear in patients. Consequently, they also use communication goals such as influencing mindset and reassuring patients. Additionally, clinicians frequently have to account for the illusion of certainty in the risk talk. CONCLUSION Risk communication is a multi-faceted construct that cannot be dealt with in isolation from the clinical context. For future research we recommend considering a more practical framework within the clinical setting and to take a goal-directed approach into account when investigating and teaching the topic. The patient perspective should also be addressed in further research.
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15
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Baessler F, Weidlich J, Schweizer S, Ciprianidis A, Bartolovic M, Zafar A, Wolf M, Wagner FL, Baumann TC, Mihaljevic AL, Ditzen B, Roesch-Ely D, Nikendei C, Schultz JH. What and how are students taught about communicating risks to patients? Analysis of a medical curriculum. PLoS One 2020; 15:e0233682. [PMID: 32470064 PMCID: PMC7259606 DOI: 10.1371/journal.pone.0233682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background Communication is a core competence in medical care. Failure of physicians to properly communicate inherent risks of medical interventions has been linked with inadequate training at school. This study analyses a medical curriculum for assessing the content and quality of teaching risk communication to students. Methods A checklist based on the national guidelines of core competencies on risk communication required of physicians was developed. Participant observers surveyed all teaching sessions at a medical school during a semester to record the frequency, characteristics and clinical context used by lectures during classes. Data were analyzed using statistical and descriptive methods to determine the prevalence and quality of teaching content. Results 231 teaching sessions were surveyed. The inter-rater reliability was 81%. Lecturers mentioned topics of risk communication in 61.5% of teaching sessions (83.7% in surgery, 43.3% in internal medicine) but core biostatistics concepts were not discussed in more than 80% of these sessions. Important topics such as patient safety and preventable diseases were underrepresented. Risk communication was mainly taught in large-group, theoretical sessions and rarely with supplementary teaching material (7.4%). Students asked questions in 15.2% of courses, more often in surgery classes than in internal medicine. Conclusion Statistical and clinical topics relevant for teaching risk communication to medical students are not only underrepresented but also minimally explained by lecturers. Supplementary material on risk communication is rarely provided to students during classes. High-resource demanding, small-group teaching formats are not necessarily interactive as students ask few questions.
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Affiliation(s)
- Franziska Baessler
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
| | - Joshua Weidlich
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Ciprianidis
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Marina Bartolovic
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Zafar
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Wolf
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabienne Louise Wagner
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Tabea Chiara Baumann
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - André L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Roesch-Ely
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Koch C, Dreimüller N, Weißkircher J, Deis N, Gaitzsch E, Wagner S, Stoll M, Bäßler F, Lieb K, Jünger J. Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial. J Gen Intern Med 2020; 35:473-480. [PMID: 31823309 PMCID: PMC7018798 DOI: 10.1007/s11606-019-05420-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/16/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk communication is a core aspect of a physician's work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI). OBJECTIVE To evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants' risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions. DESIGN A rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers. PARTICIPANTS Sixty-three medical students in their fourth or fifth year. INTERVENTIONS Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual. MAIN MEASURES Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE). KEY RESULTS Participants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen's d of 2.35 (95% confidence interval (CI) 1.62 to 3.01, p < 0.01) and of 1.83 (CI 1.13 to 2.47, p < 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (d between 0.91 and 2.04 (p < 0.001)). CONCLUSIONS Our results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge. TRIAL REGISTRATION The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.
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Affiliation(s)
- Cora Koch
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Freiburg, Germany
| | - Nadine Dreimüller
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Janosch Weißkircher
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Nicole Deis
- Department of Pneumology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva Gaitzsch
- Department of Pneumology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Marlene Stoll
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Franziska Bäßler
- Department for General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jana Jünger
- IMPP - German Institute for Medical and Pharmaceutical Examinations, Postfach 2528, 55015, Mainz, Germany.
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Yen RW, Barr PJ, Cochran N, Aarts JW, Légaré F, Reed M, O'Malley AJ, Scalia P, Painchaud Guérard G, Backer G, Reilly C, Elwyn G, Durand MA. Medical Students' Knowledge and Attitudes Toward Shared Decision Making: Results From a Multinational, Cross-Sectional Survey. MDM Policy Pract 2019; 4:2381468319885871. [PMID: 31742232 PMCID: PMC6843737 DOI: 10.1177/2381468319885871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction. We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes toward, knowledge of, and experience with shared decision making (SDM). Methods. We conducted the survey from September 2016 until May 2017 using the following: 1) a convenience sample of students from four medical schools each in Canada, the United States, and the Netherlands (n = 12), and 2) all medical schools in the United Kingdom through the British Medical School Council (n = 32). We also distributed the survey through social media. Results. A total of 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range = 18.8% to 100%; 95% confidence interval [CI] = 82.8% to 84.5%). US students had the highest knowledge scores (86.2%, 95% CI = 84.8% to 87.6%). The mean risk communication score was 57.4% (range = 0% to 100%; 95% CI = 57.4% to 60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients, and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, P < 0.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% v. 48.8%). A total of 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion. SDM knowledge is high among medical students in all four countries. Risk communication is less well understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Nan Cochran
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Johanna W Aarts
- Department of Obstetrics & Gynecology, Radboudumc University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Université Laval, Department of Family Medicine, Quebec City, Quebec, Canada
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Geneviève Painchaud Guérard
- CHU de Quebec Research Center Université Laval, Saint-François d'Assise Hospital, Quebec City, Quebec, Canada
| | - Grant Backer
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Clifford Reilly
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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Joseph-Williams N, Williams D, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, McGarrigle H, Sweetland H, Edwards A. A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study. PATIENT EDUCATION AND COUNSELING 2019; 102:1774-1785. [PMID: 31351787 DOI: 10.1016/j.pec.2019.07.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
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Affiliation(s)
- Natalie Joseph-Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK.
| | - Denitza Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Fiona Wood
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Amy Lloyd
- Cardiff University, College of Biomedical and Life Sciences, Centre for Trials Research, Cardiff, UK
| | - Katherine Brain
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Nerys Thomas
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Alison Prichard
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Annwen Goodland
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Adrian Edwards
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
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19
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Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, Lindenauer PK, Mazor KM. Physician-identified barriers to and facilitators of shared decision-making in the Emergency Department: an exploratory analysis. Emerg Med J 2019; 36:346-354. [PMID: 31097464 DOI: 10.1136/emermed-2018-208242] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/13/2019] [Accepted: 04/02/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Shared decision-making (SDM) is receiving increasing attention in emergency medicine because of its potential to increase patient engagement and decrease unnecessary healthcare utilisation. This study sought to explore physician-identified barriers to and facilitators of SDM in the ED. METHODS We conducted semistructured interviews with practising emergency physicians (EP) with the aim of understanding when and why EPs engage in SDM, and when and why they feel unable to engage in SDM. Interviews were transcribed verbatim and a three-member team coded all transcripts in an iterative fashion using a directed approach to qualitative content analysis. We identified emergent themes, and organised themes based on an integrative theoretical model that combined the theory of planned behaviour and social cognitive theory. RESULTS Fifteen EPs practising in the New England region of the USA were interviewed. Physicians described the following barriers: time constraints, clinical uncertainty, fear of a bad outcome, certain patient characteristics, lack of follow-up and other emotional and logistical stressors. They noted that risk stratification methods, the perception that SDM decreased liability and their own improving clinical skills facilitated their use of SDM. They also noted that the culture of the institution could play a role in discouraging or promoting SDM, and that patients could encourage SDM by specifically asking about alternatives. CONCLUSIONS EPs face many barriers to using SDM. Some, such as lack of follow-up, are unique to the ED; others, such as the challenges of communicating uncertainty, may affect other providers. Many of the barriers to SDM are amenable to intervention, but may be of variable importance in different EDs. Further research should attempt to identify which barriers are most prevalent and most amenable to intervention, as well as capitalise on the facilitators noted.
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Affiliation(s)
- Elizabeth M Schoenfeld
- Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.,Department of Emergency Medicine, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA
| | - Sarah L Goff
- Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.,School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Tala R Elia
- Department of Emergency Medicine, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA
| | - Errel R Khordipour
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Kye E Poronsky
- Department of Emergency Medicine, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA
| | - Kelly A Nault
- Department of Emergency Medicine, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA
| | - Peter K Lindenauer
- Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Meyers Primary Care Institute, Worcester, Massachusetts, USA
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20
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Harrison M, Han PKJ, Rabin B, Bell M, Kay H, Spooner L, Peacock S, Bansback N. Communicating uncertainty in cancer prognosis: A review of web-based prognostic tools. PATIENT EDUCATION AND COUNSELING 2019; 102:842-849. [PMID: 30579771 PMCID: PMC6491222 DOI: 10.1016/j.pec.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
Objective To review how web-based prognosis tools for cancer patients and clinicians describe aleatory (risk estimates) and epistemic (imprecision in risk estimates) uncertainties. Methods We reviewed prognostic tools available online and extracted all uncertainty descriptions. We adapted an existing classification and classified each extracted statement by presentation of uncertainty. Results We reviewed 222 different prognostic risk tools, which produced 772 individual estimates. When describing aleatory uncertainty, almost all (90%) prognostic tools included a quantitative description, such as "chances of survival after surgery are 10%", though there was heterogeneity in the use of percentages, natural frequencies, and use of graphics. Only 14% of tools described epistemic uncertainty. Of those that did, most used a qualitative prefix such as "about" or "up to", while 22 tools described quantitative descriptions using confidence intervals or ranges. Conclusions Considerable heterogeneity exists in the way uncertainties are communicated in cancer prognostic tools. Few tools describe epistemic uncertainty. This variation is predominately explained by a lack of evidence and consensus in risk communication, particularly for epistemic uncertainty. Practice Implications As precision medicine seeks to improve prognostic estimates, the community may not be equipped with the tools to communicate the results accurately and effectively to clinicians and patients.
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Affiliation(s)
- Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, 04101, USA.
| | - Borsika Rabin
- Department of Family Medicine and Public Health, School of Medicine University of California San Diego, La Jolla, CA, 92093, USA; Department of Family Medicine and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, 80045, USA.
| | - Madelaine Bell
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
| | - Hannah Kay
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, 04101, USA.
| | - Luke Spooner
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia Cancer Agency, Vancouver, BC, V5Z 1L3, Canada; Leslie Diamond Chair in Cancer Survivorship, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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21
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Ottolenghi J, Athauda G, Stumbar SE, Kashan SB, Lupi C. Contraceptive Pharmacology and Risk Communication: A Case-Based Flipped Classroom Exercise. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10790. [PMID: 30800990 PMCID: PMC6354791 DOI: 10.15766/mep_2374-8265.10790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/19/2018] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Oral contraceptives are widely used for both contraceptive and noncontraceptive purposes. Of women ages 15-44 who have ever had sexual intercourse, 88% have used at least one hormonal contraceptive method. Health care providers caring for reproductive-age women need a strong base of knowledge in hormonal contraception. Those who provide contraceptive counseling must apply this knowledge to shared decision making, including effective quantitative communication. METHODS Students and faculty at Florida International University Herbert Wertheim College of Medicine created a prerecorded lecture and in-class interactive case on contraceptive pharmacology and risk communication. The 20-minute lecture focused on mechanisms of action, bioavailability, drug-drug interaction, effectiveness, and major vascular risks of combined hormonal and progestin-only contraceptives. The 55-minute in-class session integrated knowledge of risks and effectiveness of contraception with risk communication surrounding contraceptive decision making and counseling. For the 2018 academic year, 122 first-year medical students participated in the session. Students anonymously answered three questions related to the session on their end-of-course evaluation. Student learning was assessed with five multiple-choice questions on the pharmacology final exam. RESULTS Students rated the session very positively. They highly rated the lecture's utility and the sesssion's contribution to solidifying their basic science knowledge and understanding of its clinical applications. Class average performance on the relevant final exam questions was 88.4%. DISCUSSION The lecture and case discussion successfully addressed gaps in the curriculum and provided students the opportunity to integrate multiple domains of learning. Students' perception of the materials was positive, and they demonstrated adequate learning.
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Affiliation(s)
- Joseph Ottolenghi
- Resident, Department of Obstetrics and Gynecology, Maimonides Medical Center
| | - Gagani Athauda
- Associate Professor, Department of Cellular Biology and Pharmacology, Florida International University Herbert Wertheim College of Medicine
| | - Sarah E. Stumbar
- Assistant Professor, Division of Family and Community Medicine, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine
| | - Sanaz B. Kashan
- Assistant Professor, Division of Internal Medicine, Department of Humanities, Health and Society, Florida International University Herbert Wertheim College of Medicine
| | - Carla Lupi
- Associate Dean for Faculty, Florida International University Herbert Wertheim College of Medicine; Professor, Department of Obstetrics and Gynecology, Florida International University Herbert Wertheim College of Medicine
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Wilbur K, Sahal A, Elgaily D. Communicating medication risk to cardiovascular patients in Qatar. Int J Health Care Qual Assur 2018; 31:10-19. [PMID: 29504846 PMCID: PMC5925853 DOI: 10.1108/ijhcqa-10-2016-0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Patient safety is gaining prominence in health professional curricula. Patient safety must be complemented by teaching and skill development in practice settings. The purpose of this paper is to explore how experienced pharmacists identify, prioritize and communicate adverse drug effects to patients. Design/methodology/approach A focus group discussion was conducted with cardiology pharmacy specialists working in a Doha hospital, Qatar. The topic guide sought to explore participants’ views, experiences and approaches to educating patients regarding specific cardiovascular therapy safety and tolerability. Discussions were audio-recorded and transcribed verbatim. Data were coded and organized around identified themes and sub-themes. Working theories were developed by the three authors based on relevant topic characteristics associated with the means in which pharmacists prioritize and choose adverse effect information to communicate to patients. Findings Nine pharmacists participated in the discussion. The specific adverse effects prioritized were consistent with the reported highest prevalence. Concepts and connections to three main themes described how pharmacists further tailored patient counseling: potential adverse effects and their perceived importance; patient encounter; and cultural factors. Pharmacists relied on initial patient dialogue to judge an individual’s needs and capabilities to digest safety information, and drew heavily upon experience with other counseling encounters to further prioritize this information, processes dependent upon development and accessing exemplar cases. Originality/value The findings underscore practical experience as a critical instructional element of undergraduate health professional patient safety curricula and for developing associated clinical reasoning.
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Silverman TB, Vanegas A, Marte A, Mata J, Sin M, Ramirez JCR, Tsai WY, Crew KD, Kukafka R. Study protocol: a cluster randomized controlled trial of web-based decision support tools for increasing BRCA1/2 genetic counseling referral in primary care. BMC Health Serv Res 2018; 18:633. [PMID: 30103738 PMCID: PMC6090728 DOI: 10.1186/s12913-018-3442-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND BRCA1 and BRCA2 mutations confer a substantial breast risk of developing breast cancer to those who carry them. For this reason, the United States Preventative Services Task Force (USPSTF) has recommended that all women be screened in the primary care setting for a family history indicative of a mutation, and women with strong family histories of breast or ovarian cancer be referred to genetic counseling. However, few high-risk women are being routinely screened and fewer are referred to genetic counseling. To address this need we have developed two decision support tools that are integrated into clinical care. METHOD This study is a cluster randomized controlled trial of high-risk patients and their health care providers. Patient-provider dyads will be randomized to receive either standard education that is supplemented with the patient-facing decision aid, RealRisks, and the provider-facing Breast Cancer Risk Navigation Toolbox (BNAV) or standard education alone. We will assess these tools' effectiveness in promoting genetic counseling uptake and informed and shared decision making about genetic testing. DISCUSSION If found to be effective, these tools can help integrate genomic risk assessment into primary care and, ultimately, help expand access to risk-appropriate breast cancer prevention options to a broader population of high-risk women. TRIAL REGISTRATION This trial is retrospectively registered with ClinicalTrials.gov Identifier: NCT03470402 : 20 March 2018.
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Affiliation(s)
- Thomas B Silverman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Alejandro Vanegas
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Awilda Marte
- Department of Medicine, Columbia University, New York, NY, USA
| | - Jennie Mata
- Department of Medicine, Columbia University, New York, NY, USA
| | - Margaret Sin
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Wei-Yann Tsai
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, New York, NY, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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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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Henselmans I, Smets EMA, Han PKJ, de Haes HCJC, Laarhoven HWMV. How long do I have? Observational study on communication about life expectancy with advanced cancer patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1820-1827. [PMID: 28511804 DOI: 10.1016/j.pec.2017.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine how communication about life expectancy is initiated in consultations about palliative chemotherapy, and what prognostic information is presented. METHODS Patients with advanced cancer (n=41) with a median life expectancy <1year and oncologists (n=6) and oncologists-in-training (n=7) meeting with them in consultations (n=62) to discuss palliative chemotherapy were included. Verbatim transcripts of audio-recorded consultations were analyzed using MAXqda10. RESULTS Life expectancy was addressed in 19 of 62 of the consultations. In all cases, patients took the initiative, most often through direct questions. Estimates were provided in 12 consultations in various formats: the likelihood of experiencing a significant event, point estimates or general time scales of "months to years", often with an emphasis on the "years". The indeterminacy of estimates was consistently stressed. Also their potential inadequacy was regularly addressed, often by describing beneficial prognostic predictors for the specific patient. Oncologists did not address the reliability or precision of estimates. CONCLUSION Oncologists did not initiate talk about life expectancy, they used different formats, emphasized the positive and stressed unpredictability, yet not ambiguity of estimates. PRACTICE IMPLICATIONS Prognostic communication should be part of the medical curriculum. Further research should address the effect of different formats of information provision.
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Affiliation(s)
- I Henselmans
- Academic Medical Center, Department of Medical Psychology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - E M A Smets
- Academic Medical Center, Department of Medical Psychology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA; Tufts University Clinical and Translational Sciences Institute, Boston, MA, USA
| | - H C J C de Haes
- Academic Medical Center, Department of Medical Psychology, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Cancer Center Amsterdam, Amsterdam, The Netherlands; Academic Medical Center, Department of Medical Oncology, Amsterdam, The Netherlands
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Mortsiefer A, Karger A, Rotthoff T, Raski B, Pentzek M. Examiner characteristics and interrater reliability in a communication OSCE. PATIENT EDUCATION AND COUNSELING 2017; 100:1230-1234. [PMID: 28139274 DOI: 10.1016/j.pec.2017.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To identify inter-individual examiner factors associated with interrater reliability in a summative communication OSCE in the 4th study year. METHODS The OSCE consists of 4 stations assessed with a 4-item 5-point global rating instrument. A bivariate secondary analysis of interrater reliability in relation to 4 examiner factors (gender, profession, OSCE experience, examiner training) was conducted. Intraclass correlation coefficients (ICC) were calculated and compared between examiner dyads of different similarity. RESULTS 169 pairwise ratings from 19 different examiners in 16 dyads were analysed. Interrater reliability is significantly higher in examiner dyads of same vs. different gender (ICC=0.76 (95%CI=0.65-0.83) vs. ICC=0.41 (95%CI=0.21-0.57)), in dyads of two clinicians vs. non-clinical/mixed professions (ICC=0.72 (95%CI=0.56-0.83) vs. ICC=0.57 (95%CI=0.41-0.69)), and in dyads with high vs. low/mixed OSCE experience (ICC=0.73 (95%CI 0.50-0.87) vs. ICC=0.56 (95%CI=0.41-0.69)). Participation in recent examiner training had no influence on ICCs. CONCLUSION Better concordance of ratings between clinically active examiners might be a hint for context specificity of good communication. Higher interrater reliability between examiners with same gender may indicate gender-specific communication concepts. PRACTICE IMPLICATIONS Medical faculties introducing summative assessment of communication competence should focus the influence of examiner characteristics on interrater reliability.
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Affiliation(s)
- Achim Mortsiefer
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Institute of General Practice, Werdener Str. 7, 40227 Düsseldorf, Germany
| | - André Karger
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Moorenstr. 5, 40225, Düsseldorf, Germany,.
| | - Thomas Rotthoff
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Deanery of Study and Department for Endocrinology, Diabetes, and Rheumatology, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Bianca Raski
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Deanery of Study and Clinical Institute of Psychosomatic Medicine and Psychotherapy, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Michael Pentzek
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Institute of General Practice, Werdener Str. 7, 40227 Düsseldorf, Germany.
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Dion M, Diouf NT, Robitaille H, Turcotte S, Adekpedjou R, Labrecque M, Cauchon M, Légaré F. Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial. JMIR MEDICAL EDUCATION 2016; 2:e17. [PMID: 27993760 PMCID: PMC5206485 DOI: 10.2196/mededu.6442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND DECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation. OBJECTIVE The objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition. METHODS We identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents' participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores. RESULTS The tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents' scores and therefore could tell us little about its effect on increasing their knowledge. CONCLUSION Residents' use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.
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Affiliation(s)
- Maxime Dion
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - Ndeye Thiab Diouf
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Community Health, Université Laval, Quebec, QC, Canada
| | - Hubert Robitaille
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Stéphane Turcotte
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Labrecque
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Cauchon
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Han PKJ, Joekes K, Mills G, Gutheil C, Smith K, Cochran NE, Elwyn G. Development and evaluation of the "BRISK Scale," a brief observational measure of risk communication competence. PATIENT EDUCATION AND COUNSELING 2016; 99:2091-2094. [PMID: 27544016 DOI: 10.1016/j.pec.2016.08.013] [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: 05/07/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To develop and evaluate a brief observational measure of clinical risk communication competence. METHODS A 4-item checklist-type measure, the BRISK (Brief Risk Information Skill) Scale, was developed by selecting and refining items from a more comprehensive measure of clinical risk communication competence. Six volunteer raters received brief training on the measure and then used the BRISK Scale to evaluate 52 video-recorded encounters between 2nd-year medical students and standardized patients conducted as part of an Observed Structured Clinical Examination (OSCE) involving a risk communication task. Internal consistency reliability, inter-rater reliability, and criterion validity were assessed. RESULTS Raters reported no difficulties using the BRISK Scale; scores across all raters and subjects ranged from 0 to 16 with a mean score of 6.49 (SD=3.17). The BRISK Scale showed good internal consistency reliability (α=0.64), and inter-rater reliability at the scale level (Intraclass Correlation Coefficient (ICC)=0.79 for consistency, and 0.75 for absolute agreement) and individual-item level (ICC range: 0.62-.91). Novice raters' BRISK Scale scores were highly correlated (r=0.84, p<0.01) with expert raters' scores on the Risk Communication Content measure, a more comprehensive measure of risk communication competence. CONCLUSIONS The BRISK Scale is a promising new brief observational measure of clinical risk communication competence.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States; Tufts University Clinical and Translational Sciences Institute, Boston, MA, United States.
| | - Katherine Joekes
- Centre for Medical and Healthcare Education, St George's, University of London, London, UK
| | - Greg Mills
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Kahsi Smith
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Nancy E Cochran
- Dartmouth Center for Healthcare Delivery Science, Hanover, NH, United States
| | - Glyn Elwyn
- Dartmouth Center for Healthcare Delivery Science, Hanover, NH, United States
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Chen EH, Kanzaria HK, Itakura K, Booker-Vaughns J, Yadav K, Kane BG. The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda. Acad Emerg Med 2016; 23:1362-1367. [PMID: 27442908 DOI: 10.1111/acem.13059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 01/17/2023]
Abstract
Shared decision making (SDM) is a patient-centered communication skill that is essential for all physicians to provide quality care. Like any competency or procedural skill, it can and should be introduced to medical students during their clerkships (undergraduate medical education), taught and assessed during residency training (graduate medical education), and have documentation of maintenance throughout an emergency physician's career (denoted as continuing medical education). A subgroup representing academic emergency medicine (EM) faculty, residents, content experts, and patients convened at the 2016 Academic Emergency Medicine Consensus Conference on SDM to develop a research agenda toward improving implementation of SDM through sustainable education efforts. After developing a list of potential priorities, the subgroup presented the priorities in turn to the consensus group, to the EM program directors (CORD-EM), and finally at the conference itself. The two highest-priority questions were related to determining or developing EM-applicable available tools and on-shift interventions for SDM and working to determine the proportion of the broader SDM curriculum that should be taught and assessed at each level of training. Educating patients and the community about SDM was also raised as an important concept for consideration. The remaining research priorities were divided into high-, moderate-, and lower-priority groups. Moreover, there was consensus that the overall approach to SDM should be consistent with the high-quality educational design utilized for other pertinent topics in EM.
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Affiliation(s)
- Esther H. Chen
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Hemal K. Kanzaria
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Kaoru Itakura
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Juanita Booker-Vaughns
- LA Biomedical Research Institute, Community Council; Harbor-UCLA Medical Center; Los Angeles CA
| | - Kabir Yadav
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Bryan G. Kane
- Department of Emergency Medicine; Lehigh Valley Health Network; Allentown PA
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Sladakovic J, Jansen J, Hersch J, Turner R, McCaffery K. The differential effects of presenting uncertainty around benefits and harms on treatment decision making. PATIENT EDUCATION AND COUNSELING 2016; 99:974-980. [PMID: 26823204 DOI: 10.1016/j.pec.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/17/2015] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The study aimed to determine the effects of presenting uncertainty of quantitative risk information about medication harms and benefits on intention to take medication and psychosocial outcomes. METHODS 147 participants were randomized into four hypothetical scenarios: (1) harm/benefit presented as point-estimates, (2) harm as point/benefit as range, (3) harm as range/benefit as point, (4) harm/benefit as ranges. We assessed participants' intention to take medication, understanding, decisional conflict, and perceived benefit and harm. Participants viewed the scenario again with swapped range vs. point-estimate presentations; intention was re-assessed at time 2. RESULTS There were no significant differences in intention across arms (p=0.93). There was an increase in intention to take medication between time 1 and time 2 in arm 4 (both harm/benefit presented as ranges, then point estimates). Understanding was greater when information was presented as point estimates compared to ranges, for both benefit (all questions correct: 74% vs 42%; χ2=15.28, df=2, p<0.001) and harm (all questions correct: 70% vs 43%; χ2=11.19, df=2, p=0.004) CONCLUSION: Changes in benefit information appear to be more influential in changing intention to take medication than harm information. Presenting uncertainty decreases understanding of information. PRACTICE IMPLICATION The findings may help develop optimal ways to present uncertainty.
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Affiliation(s)
- Jovana Sladakovic
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Jesse Jansen
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Robin Turner
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, Australia.
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Carney PA, Palmer RT, Fuqua Miller M, Thayer EK, Estroff SE, Litzelman DK, Biagioli FE, Teal CR, Lambros A, Hatt WJ, Satterfield JM. Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:730-42. [PMID: 26796091 PMCID: PMC4846480 DOI: 10.1097/acm.0000000000001090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. METHOD The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. RESULTS Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. CONCLUSIONS These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.
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Affiliation(s)
- Patricia A Carney
- P.A. Carney is professor of family medicine and of public health and preventive medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. R.T. Palmer is assistant professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. M.F. Miller is senior research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. E.K. Thayer is research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. S.E. Estroff is professor, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. D.K. Litzelman is D. Craig Brater Professor of Medicine and senior director for research in health professions education and practice, Indiana University School of Medicine, Indianapolis, Indiana. F.E. Biagioli is professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. C.R. Teal is assistant professor, Department of Medicine, and director, Educational Evaluation and Research, Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, Texas. A. Lambros is active emeritus associate professor, Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. W.J. Hatt is programmer analyst, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. J.M. Satterfield is professor of clinical medicine, University of California, San Francisco, School of Medicine, San Francisco, California
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Bagnasco A, Tolotti A, Pagnucci N, Torre G, Timmins F, Aleo G, Sasso L. How to maintain equity and objectivity in assessing the communication skills in a large group of student nurses during a long examination session, using the Objective Structured Clinical Examination (OSCE). NURSE EDUCATION TODAY 2016; 38:54-60. [PMID: 26803712 DOI: 10.1016/j.nedt.2015.11.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/05/2015] [Accepted: 11/15/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND While development, testing, and innovation of the Objective Structured Clinical Examination (OSCE) are common in the international literature, studies from the United States of America (USA), Australia, and the United Kingdom (UK) predominate. There is little known about OSCE use in European countries, such as Italy, where other than cost analysis, there is little reporting of OSCE use or validation. OBJECTIVES This paper reports on one Italian initiative, which evaluated the equity and objectivity of the OSCE method of assessing communication skills. DESIGN An OSCE method was used to assess the communication skills of first-year students of the Degree Course in Nursing. A method of simulation was implemented through role-playing with standardized patients. An observational method was used to collect data. PARTICIPANTS AND SETTINGS Four hundred and twenty-one first-year undergraduate nursing students at one university site in Italy took part. METHODS Ten examination sessions were carried out. The students' performances were assessed by two examiners who used a structured observation grid and conducted their assessment separately. A situation simulated by four nurses with experience as actors was used as the topic for the students' examination. RESULTS Calculation of the daily rate of students who passed the examination revealed a random distribution over time. The nonparametric correlation indexes referring to the assessments and to the scores assigned by the two examiners proved statistically significant (P≤0.001). CONCLUSIONS The study confirmed the validity of the OSCE method in ensuring equity and objectivity of communication skills assessment in a large population of nursing students for the purpose of certification throughout the duration of the examination. This has important implications for nurse education and practice as the extent to which OSCE approaches, while deemed objective, are culturally sensitive or valid and reliable across cultures is not clear. This is something that requires further research and examination in this field.
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Affiliation(s)
- Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Angela Tolotti
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, I-56100 Pisa, Italy.
| | - Giancarlo Torre
- School of Medical and Pharmaceutical Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Fiona Timmins
- School of Nursing, Trinity College, College Green, Dublin 2, Ireland.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
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Kunneman M, Stiggelbout AM, Marijnen CAM, Pieterse AH. Probabilities of benefit and harms of preoperative radiotherapy for rectal cancer: What do radiation oncologists tell and what do patients understand? PATIENT EDUCATION AND COUNSELING 2015; 98:1092-1098. [PMID: 26025810 DOI: 10.1016/j.pec.2015.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/01/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Probabilities of benefits and harms of treatment may help patients when making a treatment decision. This study aimed to examine (1) whether and how radiation oncologists convey probabilities to rectal cancer patients, and (2) patients' estimates of probabilities of major outcomes of rectal cancer treatment. METHODS First consultations of oncologists and patients eligible for preoperative radiotherapy (PRT) (N=90) were audio taped. Tapes were transcribed verbatim and coded to identify probabilistic information presented. Patients (N=56) filled in a post-consultation questionnaire on their estimates of probabilities. RESULTS Probabilities were mentioned in 99% (local recurrence), 75% (incontinence), 72% and 40% (sexual dysfunction in males and females, respectively) of cases. Most patients (89%) correctly estimated that PRT decreases the probability of local recurrence, and 10% and 38%/54% that it increases the probability of incontinence and sexual dysfunction in males/females, respectively. Patients tended to underestimate the probabilities of harms of treatment. CONCLUSION Our results show that oncologists almost always mention probabilities of benefit of PRT. In contrast, probabilities of harms often go unmentioned. The effect of PRT on adverse events is often underestimated. PRACTICE IMPLICATIONS Oncologists should stay alert to patients' possible misunderstanding of probabilistic information and should check patients' perceptions of probabilities.
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Affiliation(s)
- Marleen Kunneman
- Leiden University Medical Centre, Department of Medical Decision Making, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Leiden University Medical Centre, Department of Medical Decision Making, Leiden, the Netherlands
| | - Corrie A M Marijnen
- Leiden University Medical Centre, Department of Clinical Oncology, Leiden, the Netherlands
| | - Arwen H Pieterse
- Leiden University Medical Centre, Department of Medical Decision Making, Leiden, the Netherlands.
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Hilton NZ, Scurich N, Helmus LM. Communicating the risk of violent and offending behavior: review and introduction to this special issue. BEHAVIORAL SCIENCES & THE LAW 2015; 33:1-18. [PMID: 25693950 DOI: 10.1002/bsl.2160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
How to communicate risk of recidivism in correctional and forensic contexts has been a subject of scholarly discussion for two decades. This emerging literature, however, is sparse compared with studies on the assessment of risk for violent and offending behavior. In this special issue of Behavioral Sciences and the Law, we have gathered together empirical and review papers exemplifying promising directions and methodologies. We begin with a review of the state of the field, and lessons that can be drawn from research into medical risk assessment and risk communication, finding that many of the same principles apply to the forensic context. How risks are framed, and how numerate assessors are, affects how risk information is understood and applied. We discuss the existing research bearing on these issues, as well as the conceptual, practical, empirical, and legal implications of communicating risk using numerical or categorical risk terms. Along with the seven articles in this volume, we suggest directions for future research on measuring and communicating change, understanding and managing the statistical literacy of those who use and communicate risk assessments, and developing a theoretical framework for forensic risk communication research. We hope this volume will help integrate and invigorate research into forensic risk communication.
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Affiliation(s)
- N Zoe Hilton
- Department of Psychiatry, University of Toronto, and Waypoint Research Institute, Penetanguishene, ON, Canada
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Hoffmann TC, Bennett S, Tomsett C, Del Mar C. Brief training of student clinicians in shared decision making: a single-blind randomized controlled trial. J Gen Intern Med 2014; 29:844-9. [PMID: 24481686 PMCID: PMC4026503 DOI: 10.1007/s11606-014-2765-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/20/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared decision making is a crucial component of evidence-based practice, but a lack of training in the "how to" of it is a major barrier to its uptake. OBJECTIVE To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians. DESIGN Multi-centre randomized controlled trial. PARTICIPANTS One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities. INTERVENTION The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills. MAIN MEASURES The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays. SECONDARY OUTCOMES confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS)). KEY RESULTS Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference = 18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference = 0.9, 95 % CI 0.5 to 1.3), confidence measure (difference = 13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference = 0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale. CONCLUSIONS This brief intervention was effective in improving student clinicians' ability, attitude towards, and confidence in shared decision making facilitation. Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training.
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Affiliation(s)
- Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, 4229, Australia,
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Mortsiefer A, Immecke J, Rotthoff T, Karger A, Schmelzer R, Raski B, Schmitten JID, Altiner A, Pentzek M. Summative assessment of undergraduates' communication competence in challenging doctor-patient encounters. Evaluation of the Düsseldorf CoMeD-OSCE. PATIENT EDUCATION AND COUNSELING 2014; 95:348-355. [PMID: 24637164 DOI: 10.1016/j.pec.2014.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/18/2014] [Accepted: 02/23/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the summative assessment (OSCE) of a communication training programme for dealing with challenging doctor-patient encounters in the 4th study year. METHODS Our OSCE consists of 4 stations (breaking bad news, guilt and shame, aggressive patients, shared decision making), using a 4-item global rating (GR) instrument. We calculated reliability coefficients for different levels, discriminability of single items and interrater reliability. Validity was estimated by gender differences and accordance between GR and a checklist. RESULTS In a pooled sample of 456 students in 3 OSCEs over 3 terms, total reliability was α=0.64, reliability coefficients for single stations were >0.80, and discriminability in 3 of 4 stations was within the range of 0.4-0.7. Except for one station, interrater reliability was moderate to strong. Reliability on item level was poor and pointed to some problems with the use of the GR. CONCLUSION The application of the GR on regular undergraduate medical education shows moderate reliability in need of improvement and some traits of validity. Ongoing development and evaluation is needed with particular regard to the training of the examiners. PRACTICE IMPLICATIONS Our CoMeD-OSCE proved suitable for the summative assessment of communication skills in challenging doctor-patient encounters.
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Affiliation(s)
- Achim Mortsiefer
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany.
| | - Janine Immecke
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
| | - Thomas Rotthoff
- Deanery of Study and Department for Endocrinology and Diabetes, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
| | - André Karger
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
| | - Regine Schmelzer
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
| | - Bianca Raski
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
| | - Jürgen In der Schmitten
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
| | - Attila Altiner
- Institute of General Practice, Medical Faculty of the University of Rostock, Rostock 18057, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
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