Effectiveness of interprofessional shared decision-making training: A mixed-method study

Views, attitudes, and reported practices of nephrology nurses regarding shared decision-making in end-of-life care

BACKGROUND

End-stage renal disease (ESRD) is the final stage of chronic kidney disease. Yet dialysis is not suitable for all ESRD patients. Moreover, while shared decision-making (SDM) is the preferred model for making medical decisions, little is known about SDM between nephrology nurses and ESRD patients in Israel.

RESEARCH OBJECTIVE

Assessing the views, attitudes, practices, and ethical dilemmas of nephrology nurses in Israel regarding SDM with ESRD patients.

METHODS

Using the descriptive quantitative approach, questionnaires were completed by 444 nephrology nurses in Israel. In addition to conducting descriptive statistics, t-tests for independent samples, f-tests for analysis of variance, and both tests for independence were also performed.

ETHICAL CONSIDERATIONS

The research aims, expected advantages and risks have been explained to respondents before completing the questionnaire to secure informed consent. Anonymity and confidentiality were ensured throughout the study. The study was approved by the Research Ethics Committee at the University of Haifa (Approval # 411/21).

RESULTS

About one-third (30%-36.5%) of nurses reported discussing quality of life issues with ESRD patients, asking about their advance directives/power of attorney, exploring cultural/religious beliefs in end-of-life care, and ask about their preferred place of death. Nurses who convey high levels of patient-centered care (68.9%, p<0.0001), have high end-of-life training (76.2%, p<0.0001), and report cooperating with interdisciplinary teams (63.8%, p = 0.0415), also reported higher SDM practices than others. Nurses who refer less patients to palliative care (70%, p<0.0001) reported higher involvement in SDM compared to other nurses.

CONCLUSIONS

Nephrology nurses in Israel do not tend to implement the SDM model, despite its potential for improving quality of life for ESRD patients and their families and increasing conservative care options. Policy makers and educators in Israel should develop and implement training programs and support in the workplace, to enhance SDM between nephrology nurses and ESRD patients.

Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

OBJECTIVES

Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan.

DESIGN

In-depth interviews and thematic analysis.

SETTING

Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022.

PARTICIPANTS

21 outpatients with at least three visits for DJD and who were aware of SDM.

RESULTS

Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations.

CONCLUSIONS

In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.

Society for Simulation in Healthcare Guidelines for Simulation Training

BACKGROUND

Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist.

METHODS

Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

OBJECTIVE

These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare.

RESULTS

Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided.

CONCLUSIONS

The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.

Entering aesthetic concept into the field of patient education: A protocol for an interdisciplinary study to develop a conceptual model

BACKGROUND

According to the significance of patient education, new conceptual models are constantly required to promote pedagogical competences of health educators. In the field of educational sciences, aesthetic-based education is known as one of the effective types of curriculum planning which has shown many positive pedagogical outcomes. Thus, the researcher's assumption is that, the concept of "aesthetic education" could be transposed from educational sciences to health sciences in order to develop a new formula in the patient education process. The purpose of this study is to explain methods in detail, to develop an aesthetic-based patient education conceptual model through the concept derivation strategy.

MATERIALS AND METHODS

1. Scoping review and inductive data analysis using Walker and Avant's approach to achieve conceptual categories of the concept "aesthetic education." 2. Semi-structured qualitative interviews and directed content analysis to extract the main categories of the concept "aesthetics in the patient education process." 3. Drawing an aesthetic-based patient education conceptual model by allocating new conceptual components to each general step of the patient education process, including needs assessment, goal setting, implementation, and evaluation. 4. Modified Delphi technique to validate the final conceptual model.

RESULTS

The first phase will represent the main categories and subcategories of attributes, antecedents, and consequences of "aesthetic education." The second phase will show the main categories and subcategories of attributes, antecedents, and consequences of the new concept named "aesthetic-based patient education." In the third phase, it is expected to achieve a new conceptual model representing the components of aesthetics in the general steps of the patient education process. The fourth phase will propose the final validated conceptual model.

CONCLUSIONS

The provided study protocol can be a road map to developing derivative models through concept derivation strategy in health sciences.

Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors

Background

Effective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists.

Objective

This study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals.

Methods

A communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States-Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores.

Results

A total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training.

Conclusions

CST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.

Validation of the Novel Interprofessional Shared Decision-Making Questionnaire to Facilitate Multidisciplinary Team Building in Patient-Centered Care

To support patients in making complex and difficult decisions, it is necessary to form a team that comprises different specialists, the patient, and family members who have detailed information about the latter. Shared decision-making (SDM) is the foundation of patient-centered care; however, its structure in the context of multidisciplinary teams remains unclear. This cross-sectional study aimed to validate the novel interprofessional SDM measure ("Group's SDM measure"). We used data of 175 participants who attended SDM Workshops for Advance Care Planning. The Group's SDM measure included 10 Japanese items that could be used by small groups of multidisciplinary professionals, and the responses were rated using a 6-point Likert scale. The index exhibited a single-factor structure and high goodness of fit with residual correlation via factor analysis. We calculated Cronbach's α (α = 0.948) and McDonald's ω (ω = 0.948) and verified high internal consistency. The Group's SDM measure can be used when evaluating the SDM process where multidisciplinary professionals are involved. We hope that in the future, it will lead to the promotion of interprofessional SDM through training with the use of this measure.