1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Spinnewijn L, Scheele F, Braat D, Aarts J. Assessing the educational quality of shared decision-making interventions for residents: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 123:108187. [PMID: 38355382 DOI: 10.1016/j.pec.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many studies on educational interventions to enhance residents' shared decision-making (SDM) skills show limited improvement in SDM skills and clinical outcomes. One plausible explanation for these suboptimal results is the insufficient emphasis on the educational quality of training interventions. METHODS This review evaluates interventions' educational quality using an evaluation framework based on a previous study on effective skills transfer and a well-known SDM model. A systematic review was conducted, searching three databases until December 13, 2022. We assessed study quality by calculating MERSQI scores, examined the levels of study effects based on Kirkpatrick's model, and applied our evaluation framework to assess the interventions' educational quality. Given the heterogeneity among the studies, a meta-analysis was not feasible. RESULTS Twenty-six studies were included. Role-play and feedback were common training characteristics (65% and 54% of interventions). Only four studies (15%) met our framework's high educational quality threshold. No correlation was found between MERSQI scores and educational quality. CONCLUSIONS This review is a valuable attempt to assess the educational quality of SDM interventions beyond measuring study outcomes. PRACTICE IMPLICATIONS Future evaluation frameworks should consider study results, training characteristics, and training content. Our framework offers a sound basis for such an evaluation framework.
Collapse
Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands; VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands.
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands; OLVG hospital, Department of Healthcare Education, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| |
Collapse
|
3
|
White D, Kilshaw L, Eng D. Communication skills: simulated patient goals of care workshop for acute care clinicians. BMJ Support Palliat Care 2024; 14:94-102. [PMID: 36347567 DOI: 10.1136/spcare-2022-003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Appropriate and timely goals of patient care (GoPC) discussions are associated with improved health outcomes near the end-of-life among patients with serious illness, however, acute care clinicians report a lack of training in conducting GoPC conversations. OBJECTIVES A half-day GoPC communication workshop for acute care clinicians was delivered and evaluated. Participants were instructed in the use of communication frameworks and practiced skills in clinical scenarios with a simulated patient. METHOD Expert facilitators guided feedback towards learner identified goals during simulated GoPC discussions. Self-reported confidence in communication skills was measured with a pre-post questionnaire, which was repeated 2 months following the workshop. RESULTS 50 clinicians completed the workshop and questionnaire. A mean improvement in confidence in communication skills of 35% (p<0.001) was identified following participation, which remained elevated at 2 months (p<0.001). All participants responded that they would recommend the workshop to a colleague, and more than two-thirds went on to share their learnings with other clinicians. CONCLUSION The use of a simulated patient, communication frameworks and an expert facilitator were associated with durable improvement in confidence in GoPC communication among acute care clinicians. A half-day workshop was feasible and acceptable to participants.
Collapse
Affiliation(s)
- David White
- Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Lucy Kilshaw
- Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Derek Eng
- Palliative Care, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
4
|
Porta-Etessam J, Santos-Lasaosa S, Rodríguez-Vico J, Núñez M, Ciudad A, Díaz-Cerezo S, Comellas M, Pérez-Sádaba FJ, Lizán L, Guerrero-Peral AL. Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine. Neurol Ther 2023; 12:1319-1334. [PMID: 37310593 PMCID: PMC10310651 DOI: 10.1007/s40120-023-00495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. METHODS A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). RESULTS A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3 years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. CONCLUSION SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.
Collapse
Affiliation(s)
- J Porta-Etessam
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - S Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | | | | | | | - L Lizán
- Outcomes'10, Castellón, Spain.
- Department of Medicine, Jaume I University, Av. Sos Baynat s/n, 12071, Castellón, Spain.
| | - A L Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| |
Collapse
|
5
|
Lehane E, Curtin C, Corrigan M. Teaching strategies for shared decision-making within the context of evidence-based healthcare practice: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 109:107630. [PMID: 36689886 DOI: 10.1016/j.pec.2023.107630] [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: 10/05/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To describe the nature of teaching Shared Decision Making (SDM) within the context of Evidence Based Practice (EBP) to support development of contemporaneous EBP education programmes for healthcare learners. METHODS A scoping review following the Joanna Briggs Institute (JBI) guidance was conducted with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) used to guide reporting. RESULTS The narrative overview of 23 studies provides insight into the 'what' and 'how' of teaching SDM within the context of EBP education. A minority of studies explicitly and concurrently incorporated EBP and SDM in terms of how programme content was organised. Teaching strategies most often used regardless of learner cohort or setting included didactic, face-to-face lectures, together with role-play/modelling, small group workshops and video recordings. Programme evaluation outcomes predominantly focused on participant reactions to training and participant learning. CONCLUSION While a disconnect between EBP and SDM remains evident in healthcare programmes, increased recognition by educators to actively facilitate this interdependent relationship is emerging. PRACTICE IMPLICATIONS Intentionally structuring learning activities in a manner which demonstrates the relevance and interdependence of SDM and EBP may mitigate 'learning silos' and enhance learners' abilities to make connections required in practice.
Collapse
Affiliation(s)
- Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Catriona Curtin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mark Corrigan
- Cork Breast Research Centre, University College Cork, Cork, Ireland
| |
Collapse
|
6
|
Reifarth E, Garcia Borrega J, Kochanek M. How to communicate with family members of the critically ill in the intensive care unit: A scoping review. Intensive Crit Care Nurs 2023; 74:103328. [PMID: 36180318 DOI: 10.1016/j.iccn.2022.103328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits. METHODS We conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding. RESULTS The search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs. CONCLUSION The current approaches to communication with patients' family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.
Collapse
Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| |
Collapse
|
7
|
Amell F, Park C, Sheth P, Elwyn G, LeFrancois D. A shared decision-making communications workshop improves internal medicine resident skill, risk-benefit education, and counseling attitude. PATIENT EDUCATION AND COUNSELING 2022; 105:1018-1024. [PMID: 34362609 DOI: 10.1016/j.pec.2021.07.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We assessed the impact of a workshop on first-year medicine residents (PGY1) shared decision-making (SDM) communication skill, risk-benefit education, and attitude. METHODS A SDM skills-focused workshop was integrated into an academic medical center PGY1 ambulatory rotation in 2016-2017. Pre/post recordings of virtual Objective Structured Clinical Examinations (OSCEs) with standardized patients sharing decisions were scored using OPTION5. Risk-benefit education, including decision aid use, was measured. Pre/post surveys assessed SDM practice attitudes and perceived barriers. RESULTS 31 of 48 (65%) PGY1 workshop attendees completed pre/post OSCEs yielding 62 videos. OPTION5 scores improved from 27/100 pre to 56/100 post (p < 0.001). Pre/post increases in integration of qualitative (15/31 vs 31/31, p < 0.001) and quantitative (3/31 vs 31/31, p < 0.001) risk measures, and decision aids (1/3 vs 31/31, p < 0.001) were observed. Pro-SDM attitude of decisional neutrality increased 16.6% pre to 71.9% post-survey (P < 0.001). Barriers to SDM remain. CONCLUSION This PGY1 workshop with virtual OSCEs improved SDM communication skills, the ability to find and provide risk-benefit education, and SDM-facilitating attitude. PRACTICE IMPLICATIONS Residency programs can improve SDM skills, risk-benefit education, and attitudes with a workshop intervention. Perceived time constraints and cognitive biases regarding risk-benefit estimates should be addressed to ensure quality SDM in practice.
Collapse
Affiliation(s)
- Fred Amell
- Internal Medicine Residency Program, Einstein-Montefiore, Bronx, NY, USA.
| | - Caroline Park
- Albert Einstein College of Medicine, Einstein-Montefiore, Bronx, NY, USA
| | - Pooja Sheth
- Albert Einstein College of Medicine, Einstein-Montefiore, Bronx, NY, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Darlene LeFrancois
- Division of General Internal Medicine, Department of Medicine, Einstein-Montefiore, Bronx, NY, USA
| |
Collapse
|
8
|
Evaluation of a national programme to improve shared decision-making skills among junior medical doctors in Denmark: a mixed methods study of satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. BMC Health Serv Res 2022; 22:245. [PMID: 35197065 PMCID: PMC8867664 DOI: 10.1186/s12913-022-07639-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background Shared decision-making (SDM) is a cornerstone in patient-centred care and there has been an increase in programmes aiming to improve clinicians’ abilities to engage in it. However, the evidence for such programmes’ effectiveness on clinicians’ use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus on satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. Methods This is a mixed methods study, consisting of an online survey followed by semi-structured interviews. The participants were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed it, corresponding to a response rate of 61%. Descriptive statistics and χ2-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded, and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated. Results Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors’ perceptions of their moderate professional experience as junior doctors, and constrained by structural and cultural conditions in the context of their clinical practice. Conclusions Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added, while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07639-6.
Collapse
|
9
|
Cook M, Zonies D, Brasel K. Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient. CURRENT TRAUMA REPORTS 2020; 6:183-193. [PMID: 33145148 PMCID: PMC7595000 DOI: 10.1007/s40719-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.
Collapse
Affiliation(s)
- Mackenzie Cook
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| | - David Zonies
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| | - Karen Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| |
Collapse
|
10
|
Singh Ospina N, Toloza FJK, Barrera F, Bylund CL, Erwin PJ, Montori V. Educational programs to teach shared decision making to medical trainees: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1082-1094. [PMID: 32005556 DOI: 10.1016/j.pec.2019.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/06/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is a process of collaboration between patients and clinicians. An increasing number of educational programs to teach SDM have been developed. We aimed to summarize and evaluate the body of evidence assessing the outcomes of these programs. METHODS We conducted a systematic review of studies that aimed to teach SDM to medical trainees. Reviewers worked independently and in duplicate to select studies, extract data and evaluate the risk of bias. RESULTS Eighteen studies were included. Most studies focused on residents/fellows (61 %) and combined a didactic component with a practical experience (50 % used a standardized patient). Overall, participants reported satisfaction with the courses. The effects on knowledge, attitudes/confidence and comfort with SDM were small; no clear improvement on SDM skills was noted. Evaluation of clinical behavior and outcomes was limited (3/18 studies). Studies had moderate risk of bias. CONCLUSION Very low quality evidence suggests that educational programs for teaching SDM to medical trainees are viewed as satisfactory and have a small impact on knowledge and comfort with SDM. Their impact on clinical skills, behaviors and patient outcomes is less clear. PRACTICAL IMPLICATIONS Integration of formal and systematic outcomes evaluation (effects on behavior/clinical practice) should be part of future programs.
Collapse
Affiliation(s)
| | - Freddy J K Toloza
- Division of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, US; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US
| | | | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, US
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US; Division of Endocrinology, Mayo Clinic, Rochester, US
| |
Collapse
|
11
|
Harrington AW, Oliveira KD, Lui FY, Maerz LL. Resident Education in End-of-Life Communication and Management: Assessing Comfort Level to Enhance Competence and Confidence. JOURNAL OF SURGICAL EDUCATION 2020; 77:300-308. [PMID: 31780426 DOI: 10.1016/j.jsurg.2019.11.003] [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] [Received: 05/08/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Our primary objective was to understand residents' baseline comfort with end-of-life (EOL) communication and management and to compare this with their comfort after completion of their surgical intensive care unit (SICU) rotation. We also evaluated the association between prior training with perceived level of comfort with EOL issues, and whether the resident believed in the concept of a "better death." DESIGN, SETTING, PARTICIPANTS As a quality improvement initiative, we conducted surveys of trainees before and after their rotation in the Yale New Haven Hospital SICU. Prerotation and postrotation surveys were administered to all residents who rotated during the 2016-2017 academic year and the first half of 2017-2018. The survey consisted of 34 questions querying residents on their level of training in EOL care, their comfort with management and discussions in different EOL domains, and their beliefs about what measures would have improved their ability to provide EOL care. Residents surveyed were from general surgery, emergency medicine, or anesthesia departments. RESULTS AND CONCLUSIONS Our study demonstrates that there is a significant correlation between resident comfort with EOL communication and experience providing EOL care. However, concepts in medicolegal aspects of palliative care could be taught through formal didactics, and structured training may allow residents the opportunity to reflect on the importance of a "better death."
Collapse
Affiliation(s)
| | - Kristin D Oliveira
- Yale School of Medicine, Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, New Haven, Connecticut
| | - Felix Y Lui
- Yale School of Medicine, Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, New Haven, Connecticut
| | - Linda L Maerz
- Yale School of Medicine, Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, New Haven, Connecticut
| |
Collapse
|
12
|
Coates D, Clerke T. Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:100-119. [PMID: 32433322 DOI: 10.1097/ceh.0000000000000289] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. METHOD A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. RESULTS The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. DISCUSSION Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
Collapse
Affiliation(s)
- Dominiek Coates
- Dr. Coates: Senior Research Fellow, University of Technology Sydney, Faculty of Health, Sydney, Australia.Clerke: Project Officer, Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia
| | | |
Collapse
|
13
|
Parham D, Reed D, Olicker A, Parrill F, Sharma J, Brunkhorst J, Noel-MacDonnell J, Voos K. Families as educators: a family-centered approach to teaching communication skills to neonatology fellows. J Perinatol 2019; 39:1392-1398. [PMID: 31371832 DOI: 10.1038/s41372-019-0441-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether the use of family members as educators in a structured educational intervention would increase neonatology fellows' confidence in performing core communication skills targeted to guide family decision-making. STUDY DESIGN Neonatology fellows at two centers participated in simulation-based training utilizing formally trained family members of former patients. Fellows completed self-assessment surveys before participating, immediately following participation, and 1-month following the training. Family members also evaluated fellow communication. RESULTS For each core competency assessed, there was a statistically significant increase in self-perceived preparedness from pre-course to post-course assessments. Fellows additionally endorsed using skills learned in the curriculum in daily clinical practice. Family educators rated fellow communication highest in empathetic listening and nonverbal communication. CONCLUSIONS Participation in a communication skills curriculum utilizing formally trained family members as educators for medical trainees successfully increased fellows' self-perceived preparedness in selected core competencies in communication. Family educators provided useful, generalizable feedback.
Collapse
Affiliation(s)
- Danielle Parham
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Danielle Reed
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Arielle Olicker
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Fey Parrill
- Department of Cognitive Science, Case Western Reserve University, Cleveland, OH, USA
| | - Jotishna Sharma
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jessica Brunkhorst
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Janelle Noel-MacDonnell
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kristin Voos
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| |
Collapse
|
14
|
Schwartz DB, Pavic-Zabinski K, Tull K. Role of the Nutrition Support Clinician on a Hospital Bioethics Committee. Nutr Clin Pract 2019; 34:869-880. [PMID: 31464002 DOI: 10.1002/ncp.10378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hospital bioethics committees comprise a diverse group of healthcare professionals to deal with ethical issues within the institution that arise during patient care. The nutrition support clinicians (NSCs) have an important role on a bioethics committee because of their knowledge and expertise of different nutrition routes and the benefits vs burdens and risks of these modalities, both enteral and parenteral nutrition. Ethics expertise is built on an understanding of ethical principles, when applied in clinical ethics, using critical thinking to prevent ethical dilemmas and to assist in healthcare decision making with a focus on patient-centered care. The NSCs have the opportunity to address ethics during direct patient care with their participation in the intensive care unit interprofessional rounds, family meetings, and surrogate meetings. Evident in ethical dilemmas is often the lack of advance care planning by patients and their family members concerning healthcare wishes for when the individual is unable to communicate their preferences for life-sustaining therapies, including nutrition support. NSCs, as hospital bioethics committee members, are able to support the initiative of National Healthcare Decisions Day to help educate other healthcare clinicians and the public about the importance of advance care planning with communication of healthcare wishes and completion of an advance directive. Components addressed in the article are incorporated into a comprehensive ethics case study, highlighting the role of NSCs.
Collapse
Affiliation(s)
| | | | - Katherine Tull
- Providence Saint Joseph Medical Center, Burbank, California, USA
| |
Collapse
|
15
|
Müller E, Strukava A, Scholl I, Härter M, Diouf NT, Légaré F, Buchholz A. Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies. BMJ Open 2019; 9:e026488. [PMID: 31230005 PMCID: PMC6596948 DOI: 10.1136/bmjopen-2018-026488] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/27/2019] [Accepted: 06/06/2019] [Indexed: 01/16/2023] Open
Abstract
DESIGN AND OBJECTIVES We performed a systematic review of studies evaluating healthcare provider (HCP) trainings in shared decision-making (SDM) to analyse their evaluation strategies. SETTING AND PARTICIPANTS HCP trainings in SDM from all healthcare settings. METHODS We searched scientific databases (Medline, PsycInfo, CINAHL), performed reference and citation tracking, contacted experts in the field and scanned the Canadian inventory of SDM training programmes for healthcare professionals. We included articles reporting data of summative evaluations of HCP trainings in SDM. Two reviewers screened records, assessed full-text articles, performed data extraction and assessed study quality with the integrated quality criteria for review of multiple study designs (ICROMS) tool. Analysis of evaluation strategies included data source use, use of unpublished or published measures and coverage of Kirkpatrick's evaluation levels. An evaluation framework based on Kirkpatrick's evaluation levels and the Quadruple Aim framework was used to categorise identified evaluation outcomes. RESULTS Out of 7234 records, we included 41 articles reporting on 30 studies: cluster-randomised (n=8) and randomised (n=9) controlled trials, controlled (n=1) and non-controlled (n=7) before-after studies, mixed-methods (n=1), qualitative (n=1) and post-test (n=3) studies. Most studies were conducted in the USA (n=9), Germany (n=8) or Canada (n=7) and evaluated physician trainings (n=25). Eleven articles met ICROMS quality criteria. Almost all studies (n=27) employed HCP-reported outcomes for training evaluation and most (n=19) additionally used patient-reported (n=12), observer-rated (n=10), standardised patient-reported (n=2) outcomes or training process and healthcare data (n=10). Most studies employed a mix of unpublished and published measures (n=17) and covered two (n=12) or three (n=10) Kirkpatrick's levels. Identified evaluation outcomes covered all categories of the proposed framework. CONCLUSIONS Strategies to evaluate HCP trainings in SDM varied largely. The proposed evaluation framework maybe useful to structure future evaluation studies, but international agreement on a core set of outcomes is needed to improve evidence. PROSPERO REGISTRATION NUMBER CRD42016041623.
Collapse
Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Strukava
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ndeye Thiab Diouf
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
16
|
Rajdev K, Loghmanieh N, Farberov MA, Demissie S, Maniatis T. Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States. J Intensive Care Med 2018; 35:1080-1094. [PMID: 30501452 DOI: 10.1177/0885066618811794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers' self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient's poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.
Collapse
Affiliation(s)
- Kartikeya Rajdev
- Department of Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Nina Loghmanieh
- Department of Palliative Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Maria A Farberov
- Department of Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Seleshi Demissie
- Department of Biostatistics, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Theodore Maniatis
- Department of Pulmonary and Critical Care Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| |
Collapse
|
17
|
Rusiecki J, Schell J, Rothenberger S, Merriam S, McNeil M, Spagnoletti C. An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:937-942. [PMID: 29068819 DOI: 10.1097/acm.0000000000001967] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Shared decision making (SDM) is a core competency in health policy and guidelines. Most U.S. internal medicine residencies lack an SDM education curriculum. A standardized patient (SP)-based curriculum teaching key concepts and skills of SDM was developed. METHOD This curriculum consisted of an innovative seven-step SDM model and a skills-focused SP case, integrated into the ambulatory rotation for senior medicine residents at the University of Pittsburgh Medical Center in 2015. Evaluation consisted of pre/postcurriculum surveys assessing residents' knowledge of and attitudes toward SDM. Skills development was assessed via pre/postcurricular audio recordings of clinical decision making. RESULTS Thirty-six residents completed the curriculum (survey participation rate 88%). There was significant improvement in residents' knowledge (median score pre 75%, post 100%, P < .01); confidence (median composite score pre 2.87, post 3.0, P < .01, where 1 = not confident/important, 4 = very confident/important); and importance of SDM (median composite score pre 3.14, post 3.5, P < .01). Forty-four clinical recordings (31 pre, 13 post) were assessed using the Observing Patient Involvement in Decision-Making scale. Improvement in use of SDM skills was seen among all residents (mean increase 1.84 points, P = .27). When data were stratified post hoc by U.S. versus international medical graduates, there was significant improvement in total score (mean increase of 5.15 points, P = .01) among U.S. graduates only. CONCLUSIONS SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents' knowledge of, attitudes toward, and demonstration of SDM skills.
Collapse
Affiliation(s)
- Jennifer Rusiecki
- J. Rusiecki is assistant professor of medicine, Division of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois. At the time this research was conducted, she was a general internal medicine fellow, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. J. Schell is assistant professor of medicine, Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. S. Rothenberger is assistant professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and statistician, Center for Research on Health Care Data Center, Pittsburgh, Pennsylvania. S. Merriam is clinical instructor of medicine and general internal medicine fellow, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. M. McNeil is professor of medicine and associate chief, Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. C. Spagnoletti is associate professor of medicine, director, Academic Clinician-Educator Scholars Fellowship in General Internal Medicine, and director, Mater's Program in Medical Education, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
18
|
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.
Collapse
|
19
|
Parikh RB, Khullar D. On the ground floor looking up—Managing trainees' uncertainty at the end of life. Healthcare (Basel) 2017; 5:155-157. [DOI: 10.1016/j.hjdsi.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 11/24/2022] Open
|
20
|
Zante B, Schefold JC. Teaching End-of-Life Communication in Intensive Care Medicine: Review of the Existing Literature and Implications for Future Curricula. J Intensive Care Med 2017; 34:301-310. [PMID: 28659041 DOI: 10.1177/0885066617716057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES: End-of-life (EOL) situations are common in the intensive care unit (ICU). Poor communication in respective situations may result in conflict and/or post-traumatic stress disorder in patients' next of kin. Thus, training for EOL communication seems pivotal. Primary objective of the current report was to identify approaches for educational programs in the ICU with regard to EOL communication as well as to conclude on implications for future curricula. MATERIALS AND METHODS: A literature review in MEDLINE, EMBASE, and PsychINFO was performed. A total of 3484 articles published between 2000 until 2016 were assessed for eligibility. Nine articles reporting on education in EOL communication in the ICU were identified and analyzed further. RESULTS: The duration of EOL workshops ranged from 3 hours to 3 days, with several different educational methods being applied. Mounting data suggest improved comfort, preparedness, and communication performance in EOL providers following specific EOL training. Due to missing data, the effect of EOL training programs on respective patients' next of kin remains unclear. CONCLUSION: Few scientific investigations focus on EOL communication in intensive care medicine. The available evidence points to increased comfort and EOL communication performance following specific individual EOL training. Given the general importance of EOL communication, we suggest implementation of educational EOL programs. When developing future educational programs, educators should consider previous experience of participants, clearly defined objectives based on institutional needs, and critical care society recommendations to ensure best benefit of all involved parties.
Collapse
Affiliation(s)
- Bjoern Zante
- 1 Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C Schefold
- 1 Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
21
|
The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes. Ann Am Thorac Soc 2017; 13:512-21. [PMID: 26989925 DOI: 10.1513/annalsats.201508-495oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In high-acuity settings such as intensive care units (ICUs), the quality of communication with patients' families is a particularly important component of care. Evidence shows that ICU communication is often inadequate and can negatively impact family outcomes. OBJECTIVES To assess the impact of a communication training program on resident skills in communicating with families in an ICU and on family outcomes. METHODS We conducted a prospective, single-site educational intervention study. The intervention featured a weekly required communication training program (4 h total) during the ICU rotation, which included interactive discussion, and role play with immediate feedback from simulated family members. All internal medicine residents on ICU rotation between July 2012 and July 2014 were invited to participate in the study. Family members who had a meeting with an enrolled resident were approached for a survey or interview. The primary outcome was family ratings of how well residents met their informational and emotional needs. MEASUREMENTS AND MAIN RESULTS The response rate for the resident baseline survey was 93% (n = 149 of 160), and it was 90% at postcourse and 84% at 3-month follow-up. Of 303 family members approached, 237 were enrolled. Enrolled family members who had a confirmed meeting with a resident were eligible to complete a survey or interview. The completion rate was 86% (n = 82 of 95). Family members were more likely to describe residents as having "fully met" (average rating of 10/10 on 0-10 scale) their informational and emotional needs when the resident had completed two or three course sessions (84% of family members said conversation with these residents "fully met" their needs), as compared with residents who had taken one session or no sessions (25% of family members said needs were "fully met") (P < 0.0001). Residents described improvements across all domains. All differences are statistically significant, most with large effect sizes. CONCLUSIONS At our institution, an on-site communication training program designed for integration into medical residency programs was associated with strongly positive family member outcomes and significant improvements in residents' perceived skills. This intervention may serve to prepare residents for optimal communications with patients and family members in ICUs and elsewhere.
Collapse
|
22
|
Schwartz DB, Armanios N, Monturo C, Frankel EH, Wesley JR, Patel M, Goldman B, Kliger G, Schwartz E. Clinical Ethics and Nutrition Support Practice: Implications for Practice Change and Curriculum Development. J Acad Nutr Diet 2016; 116:1738-1746. [DOI: 10.1016/j.jand.2016.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Indexed: 11/29/2022]
|
23
|
Hale A, Glassman R, Fessler D, Mukamal KJ, Stead W. Meeting the needs of the resident trainee during an elective subspecialty rotation. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:115-118. [PMID: 27062221 PMCID: PMC4826764 DOI: 10.5116/ijme.56f5.c7ec] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine and compare perceptions between resident-trainees and faculty-educators on goals and reasons why resident trainees choose certain subspecialty elective rotations. METHODS In June 2013 residents and faculty-educators at a large tertiary care academic medical center were surveyed regarding perceived resident goals for subspecialty electives. Each group was sent a different electronic survey of parallel questions assessing agreement on an ordered scale with statements about which factors impacted resident choice. RESULTS The survey was sent to 154 residents and had 75 (49%) respondents, as well as 20 faculty-educators with 12 (60%) respondents. Residents and faculty did not differ in their responses that electives were chosen to fill perceived knowledge gaps (exact Cochran-Armitage p = .51). However, educators and residents significantly varied in the degree to which they thought resident choice was based on networking within the field (exact Cochran-Armitage p = .01), auditioning for fellowship (exact Cochran-Armitage p < .01), or exploring career options (exact Cochran-Armitage p = .01), with educators overestimating the degree to which these impacted resident choice. CONCLUSIONS Resident trainees and faculty educators agree that subspecialty electives are most frequently chosen in order to meet resident educational goals, highlighting the importance of developing and delivering high quality subspecialty curricular content for the internal medicine resident learner during electives. Many residents choose electives for career development reasons, but faculty educators overestimate this motivation.
Collapse
Affiliation(s)
- Andrew Hale
- Division of Infectious Disease at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - Rebecca Glassman
- Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - David Fessler
- Division of Infectious Disease at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - Kenneth J. Mukamal
- Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - Wendy Stead
- Division of Infectious Disease at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| |
Collapse
|
24
|
Schwartz DB, Olfson K, Goldman B, Barrocas A, Wesley JR. Incorporating Palliative Care Concepts Into Nutrition Practice: Across the Age Spectrum. Nutr Clin Pract 2016; 31:305-15. [PMID: 26888858 DOI: 10.1177/0884533615621556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A practice gap exists between published guidelines and recommendations and actual clinical practice with life-sustaining treatments not always being based on the patient's wishes, including the provision of nutrition support therapies. Closing this gap requires an interdisciplinary approach that can be enhanced by incorporating basic palliative care concepts into nutrition support practice. In the fast-paced process of providing timely and effective medical treatments, communication often suffers and decision making is not always reflective of the patient's quality-of-life goals. The current healthcare clinical ethics model does not yet include optimum use of advance directives and early communication between patients and family members and their healthcare providers about treatment choices, including nutrition support. A collaborative, proactive, integrated process in all healthcare facilities and across levels of care and age groups, together with measurable sustained outcomes, shared best practices, and preventive ethics, will be needed to change the culture of care. Implementation of a better process, including basic palliative care concepts, requires improved communication skills by healthcare professionals. Formalized palliative care consults are warranted early in complex cases. An education technique, as presented in this article, of how clinicians can engage in critical and crucial conversations early with patients and family members, by incorporating the patient's values and cultural and religious diversity in easily understood language, is identified as an innovative tool.
Collapse
Affiliation(s)
| | | | - Babak Goldman
- Providence Saint Joseph Medical Center, Burbank, California
| | | | - John R Wesley
- Feinberg School of Medicine, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| |
Collapse
|
25
|
Karabilgin OS, Altug N, Caliskan SA, Bozoklar CA, Durak HI, Demiral-Yilmaz N. Withdrawn: Simulated Donor Family Encounters at Organ Transplantation Coordinators In-service Training Course: Process and Impact Evaluation. Transplant Proc 2015; 47:1572-9. [PMID: 26293015 DOI: 10.1016/j.transproceed.2015.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/04/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study was aimed at introducing the modified version of the organ transplantation coordinator course including simulated donor family encounters (SDFEs), communication skills, and evaluating the participants' opinions, achievement levels, and how they implemented what they learned in the course in their work settings. METHODS The course was modified using the ADDIE (analysis, design, development, implementation, and evaluation) model and was evaluated in three steps: The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the post-test and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through phone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. RESULTS The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly use their communication and empathy skills during donor family encounters. The participants' mean post-test score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. CONCLUSION It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.
Collapse
Affiliation(s)
- O S Karabilgin
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey
| | - N Altug
- Ege University Faculty of Medicine, Organ Transplantation Application and Research Center, Izmir, Turkey
| | - S A Caliskan
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey
| | - C A Bozoklar
- Istanbul Bilim University Faculty of Medicine, General Surgery, Istanbul, Turkey
| | - H I Durak
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey
| | - N Demiral-Yilmaz
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey.
| |
Collapse
|
26
|
Bergman J, Ballon-Landa E, Lerman SE, Kwan L, Bennett CJ, Litwin MS. Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education. Am J Hosp Palliat Care 2015; 33:748-54. [PMID: 26261373 DOI: 10.1177/1049909115598741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. METHODS Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. RESULTS 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p < .01) were all associated with linking to auxiliary resources via hyperlinks. When adjusting for confounders, β coefficient estimates and least squares estimation demonstrated that participants clicking on both hyperlink types were more likely to score higher on all knowledge and attitude items, and demonstrate increased score improvements. CONCLUSION Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care.
Collapse
Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Eric Ballon-Landa
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA University of California Irvine School of Medicine, Irvine, CA, USA
| | - Steven E Lerman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol J Bennett
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
27
|
Markin A, Cabrera-Fernandez DF, Bajoka RM, Noll SM, Drake SM, Awdish RL, Buick DS, Kokas MS, Chasteen KA, Mendez MP. Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit. Crit Care Res Pract 2015; 2015:534879. [PMID: 26199755 PMCID: PMC4496471 DOI: 10.1155/2015/534879] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the "VitalTalk" method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value), including discussing bad news (3.3; 4.2; p < 0.01), conducting a family conference (3.1; 4.1; p < 0.01), discussing treatment options (3.2; 3.9; p < 0.01), discussing discontinuing ICU treatments (2.9; 3.5; p < 0.01), and expressing empathy (3.9; 4.5; p < 0.01). Improvement persisted at follow-up for all items except "expressing empathy." Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents' confidence to discuss EOL care with family members of patients in the ICU.
Collapse
Affiliation(s)
- Abraham Markin
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | | | - Rebecca M. Bajoka
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Samantha M. Noll
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Sean M. Drake
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Rana L. Awdish
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Dana S. Buick
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Maria S. Kokas
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Kristen A. Chasteen
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Michael P. Mendez
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| |
Collapse
|
28
|
Simulated Donor Family Encounters at Organ Transplantation Coordinators In-Service Training Course: Process and Impact Evaluation. Transplant Proc 2015; 47:1249-56. [PMID: 26093692 DOI: 10.1016/j.transproceed.2015.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study introduced the modified version of the Organ Transplantation Coordinator course including simulated donor family encounters (SDFEs) and communication skills. It also evaluated participants' opinions and achievement levels, and how they implemented what they learned in the course in their work settings. METHODS The course used the modified Analysis, Design, Development, Implementation, and Evaluation model and was evaluated in 3 steps. The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the posttest and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through telephone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. RESULTS The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly utilize their communication and empathy skills during donor family encounters. The participants' mean posttest score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. CONCLUSIONS It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.
Collapse
|
29
|
How clinicians discuss critically ill patients' preferences and values with surrogates: an empirical analysis. Crit Care Med 2015; 43:757-64. [PMID: 25565458 DOI: 10.1097/ccm.0000000000000772] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although shared decision making requires clinicians to discuss the patient's values and preferences, little is known about the extent to which this occurs with surrogates in ICUs. We sought to assess whether and how clinicians talk with surrogates about incapacitated patients' preferences and values. DESIGN Prospective, cross-sectional study. SETTING Five ICUs of two hospitals. SUBJECTS Fifty-four physicians and 159 surrogates for 71 patients. INTERVENTIONS We audio-recorded 71 conferences in which clinicians and surrogates discussed life-sustaining treatment decisions for an incapacitated patient near the end of life. Two coders independently coded each instance in which clinicians or surrogates discussed the patient's previously expressed treatment preferences or values. They subcoded for values that are commonly important to patients near the end of life. They also coded treatment recommendations by clinicians that incorporated the patient's preferences or values. MEASUREMENTS AND MAIN RESULTS In 30% of conferences, there was no discussion about the patient's previously expressed preferences or values. In 37%, clinicians and surrogates discussed both the patient's treatment preferences and values. In the remaining 33%, clinicians and surrogates discussed either the patient's treatment preferences or values, but not both. In more than 88% of conferences, there was no conversation about the patient's values regarding autonomy and independence, emotional well-being and relationships, physical function, cognitive function, or spirituality. On average, 3.8% (SD, 4.3; range, 0-16%) of words spoken pertained to patient preferences or values. CONCLUSIONS In roughly a third of ICU family conferences for patients at high risk of death, neither clinicians nor surrogates discussed patients' preferences or values about end-of-life decision making. In less than 12% of conferences did participants address values of high importance to most patients, such as cognitive and physical function. Interventions are needed to ensure patients' values and preferences are elicited and integrated into end-of-life decisions in ICUs.
Collapse
|
30
|
Adams AMN, Mannix T, Harrington A. Nurses' communication with families in the intensive care unit - a literature review. Nurs Crit Care 2015; 22:70-80. [DOI: 10.1111/nicc.12141] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/13/2014] [Accepted: 09/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- AMN Adams
- MNg; University Hospital of Northern Norway, Intensiv avdeling; 9038 Tromsø Norway
| | - T Mannix
- School of Nursing and Midwifery; Flinders University, Adelaide; GPO Box 2100 Adelaide South Australia Australia
| | - A Harrington
- School of Nursing and Midwifery; Flinders University, Adelaide; GPO Box 2100 Adelaide South Australia Australia
| |
Collapse
|
31
|
|
32
|
Abstract
The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model. Nutrition support clinicians have an opportunity to add another dimension to their practice with the incorporation of patient-centered care and clinical ethics. This represents a culture change for healthcare professionals, including nutrition support clinicians, patients and their family. All of these individuals are stakeholders in the process and have the ability to modify the current healthcare system to improve communication and facilitate a change by humanizing nutrition support practice. Nutrition support is a medical, life-sustaining treatment, and the use of this therapy requires knowledge by the nutrition support clinician of patient-centered care concepts, preventive clinical ethics, religion/spirituality and cultural diversity, palliative care team role, and advance care planning. Integrating these into the practice of nutrition support is an innovative approach and results in new knowledge that requires a change in the culture of care and engagement and empowerment of the patient and their family in the process. This is more than a healthcare issue; it involves a social/family conversation movement that will be enhanced by the nutrition support clinician's participation.
Collapse
Affiliation(s)
- Denise Baird Schwartz
- Denise Baird Schwartz, CNSC, Nutrition Support Coordinator, Providence Saint Joseph Medical Center, 501 South Buena Vista Street, Burbank, CA, 91505, USA.
| |
Collapse
|