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Sandhu A, Grad R, Bousbiat I, Issa AM, Abbasgolizadeh-Rahimi S, D'Souza V, Elwyn G. Family medicine residents' perspectives on shared decision-making: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2024; 128:108373. [PMID: 39018780 DOI: 10.1016/j.pec.2024.108373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/19/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVES To 1) examine the willingness of residents to undertake shared decision-making and 2) explore whether the willingness to engage in shared decision-making is influenced by the perceived stakes of a clinical situation. METHODS Sequential mixed methods design. Phase One: Family Medicine residents completed IncorpoRATE, a seven-item measure of clinician willingness to engage in shared decision making. Mean IncorpoRATE scores were calculated. Phase Two: We interviewed residents from phase one to explore their perceptions of high versus low stakes situations. Transcripts were analyzed using qualitative content analysis. RESULTS IncorpoRATE scores indicated a greater willingness to engage in shared decision-making when the stakes of the decision were perceived as low (7.59 [2.0]) compared to high (4.38 [2.5]). Interviews revealed that residents held variable views of the stakes of similar clinical decisions. CONCLUSION Residents are more willing to engage in shared decision-making when the stakes of the situation are perceived to be low. However, the interpretation of the stakes of clinical situations varies. PRACTICAL IMPLICATIONS Further research is needed to explore how shared decision making is understood by residents in Family Medicine and when they view the process of shared decision-making to be most appropriate.
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Affiliation(s)
- Amrita Sandhu
- Department of Family Medicine, McGill University, Montréal, Canada; Mila-Quebec AI Institute, Montreal, Canada.
| | - Roland Grad
- Department of Family Medicine, McGill University, Montréal, Canada; Lady Davis Institute for Medical Research, Montreal, Canada
| | - Ilhem Bousbiat
- Department of Family Medicine, McGill University, Montréal, Canada; Mila-Quebec AI Institute, Montreal, Canada
| | - Amalia M Issa
- Department of Family Medicine, McGill University, Montréal, Canada; Personalized Precision Medicine and Targeted Therapeutics Institute, Springfield, PA, USA
| | - Samira Abbasgolizadeh-Rahimi
- Department of Family Medicine, McGill University, Montréal, Canada; Lady Davis Institute for Medical Research, Montreal, Canada; Mila-Quebec AI Institute, Montreal, Canada
| | - Vinita D'Souza
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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Spinnewijn L, Scheele F, Braat D, Aarts J. Assessing the educational quality of shared decision-making interventions for residents: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 123:108187. [PMID: 38355382 DOI: 10.1016/j.pec.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many studies on educational interventions to enhance residents' shared decision-making (SDM) skills show limited improvement in SDM skills and clinical outcomes. One plausible explanation for these suboptimal results is the insufficient emphasis on the educational quality of training interventions. METHODS This review evaluates interventions' educational quality using an evaluation framework based on a previous study on effective skills transfer and a well-known SDM model. A systematic review was conducted, searching three databases until December 13, 2022. We assessed study quality by calculating MERSQI scores, examined the levels of study effects based on Kirkpatrick's model, and applied our evaluation framework to assess the interventions' educational quality. Given the heterogeneity among the studies, a meta-analysis was not feasible. RESULTS Twenty-six studies were included. Role-play and feedback were common training characteristics (65% and 54% of interventions). Only four studies (15%) met our framework's high educational quality threshold. No correlation was found between MERSQI scores and educational quality. CONCLUSIONS This review is a valuable attempt to assess the educational quality of SDM interventions beyond measuring study outcomes. PRACTICE IMPLICATIONS Future evaluation frameworks should consider study results, training characteristics, and training content. Our framework offers a sound basis for such an evaluation framework.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands; VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands.
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands; OLVG hospital, Department of Healthcare Education, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
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Vu PD, Malik A, Cohen AS, Bansal V, Cowan MR, Blazek GM, Champagne-Langabeer T. Shared Decision Making in Acute Pain Management in Patients with Opioid Use Disorder: A Scoping Review. J Clin Med 2023; 12:jcm12103555. [PMID: 37240661 DOI: 10.3390/jcm12103555] [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: 02/22/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is used in acute pain management in patients with OUD. We searched Medline, Embase, CINAHL, and PsychInfo databases for relevant articles. Articles were screened and SDM outcomes of eligible articles were charted. The results were grouped by sub-theme based on a 1997 SDM model. There were three original research studies and one quality improvement study. The remaining articles were split evenly between reviews and reviews of clinical guidelines. Four themes emerged from the review: prior judgment and stigma related to OUD, trust and sharing of information, clinical tools, and interprofessional teams. This scoping review consolidated and expounded the current literature on SDM in the management of acute pain in patients with OUD. More work is needed to address prior judgments by both providers and patients and to build greater dialogue. Clinical tools may aid this process as well as the involvement of a multidisciplinary team.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - A Sarah Cohen
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, 7000 Fannin, Houston, TX 77030, USA
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Morgan R Cowan
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Gregory M Blazek
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, 7000 Fannin, Houston, TX 77030, USA
- Tiffany Champagne-Langabeer, UTHealth Houston, 7000 Fannin St., Suite 600, Houston, TX 77030, USA
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Yu SF, Wang HT, Chang MW, Cheng TT, Chen JF, Lin CL, Yu HT. Determining the Development Strategy and Suited Adoption Paths for the Core Competence of Shared Decision-Making Tasks through the SAA-NRM Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13310. [PMID: 36293890 PMCID: PMC9602580 DOI: 10.3390/ijerph192013310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Shared decision making (SDM) is an interactive process that involves patients and their healthcare professionals reaching joint decisions about medical care through negotiation. As the initiators of medical decision-making in daily routine, physicians should be aware of and concerned about the SDM process. Thus, professional competency development for SDM has become increasingly critical for physicians' training. Therefore, this study investigates the professional competency and the important competency development aspects/criteria of SDM tasks through expert interviews and literature research. The study adopts the SAA (satisfaction-attention analysis) method to assess the status of competency development aspects/criteria and determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The results demonstrate that the CE (concept and evaluation) aspect is the dominant aspect, and the CR (communication and relationship) aspect is the aspect being dominated. The CE aspect influences the aspects of SP (skill and practice), JM (joint information and decision making) and CR, and the SP aspect affects the aspects of JM and CR. Then, the JM aspect affects the CR aspect. The study also suggests suitable adoption paths of competency development for SDM tasks using the NRM approach. It provides recommendations and strategic directions for SDM competency development and sustainable training programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Meng-Wei Chang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei 105, Taiwan
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Yu SF, Hsu CM, Wang HT, Cheng TT, Chen JF, Lin CL, Yu HT. Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach. Healthcare (Basel) 2022; 10:healthcare10101844. [PMID: 36292290 PMCID: PMC9601707 DOI: 10.3390/healthcare10101844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022] Open
Abstract
Shared decision making (SDM) is a collaborative process involving patients and their healthcare workers negotiating to reach a shared decision about medical care. However, various physician stakeholders (attending physicians, medical residents, and doctors in post-graduate years) may have different viewpoints on SDM processes. The purpose of this study is to explore the core competence of physicians in performing SDM tasks and to investigate the significant competency development aspects/criteria by applying the literature research and expert interviews. We adopt the IAA (importance awareness analysis) technique for different stakeholders to evaluate the status of competency development aspects/criteria and to determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The study combines the IAA and NRM methods and suggests using the IAA-NRM approach to evaluate the adoption strategies and common suitable paths for different levels of physicians. Our findings reveal that SDM perception and practice is the primary influencer of SDM competence development for all stakeholders. The current model can help hospital administrators and directors of medical education understand the diverse stakeholders’ perspectives on the core competence of SDM tasks and determine common development plans. It provides strategic directions for SDM competency development and talent cultivation programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan City 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan
| | - Chih-Ming Hsu
- Medical Education Department, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
- Department of Business Administration, National Chung Cheng University, Minxiong Township, Chiayi 621, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan City 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei City 111, Taiwan
- Correspondence: (C.-L.L.); (H.-T.Y.)
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei City 105, Taiwan
- Correspondence: (C.-L.L.); (H.-T.Y.)
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Selby K, Durand MA, von Plessen C, Auer R, Biller-Andorno N, Krones T, Agoritsas T, Cornuz J. Shared decision-making and patient and public involvement: Can they become standard in Switzerland? ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:135-138. [PMID: 35610134 DOI: 10.1016/j.zefq.2022.04.019] [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: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
The Swiss healthcare system is highly decentralized, making implementation of shared decision making (SDM) and patient and public involvement (PPI) quite slow; nonetheless, change is happening. SDM is now a core communication competency for medical school graduates, as reflected by a dedicated station on the federal exam, and is endorsed by several national societies. Multiple local initiatives are contributing to international best practices, local implementation, and increased capacity. PPI is also gaining momentum, most notably in research, with the development of a national platform for clinical research and inclusion of patients in the evaluation committees for funding. The challenge now is going from example projects by motivated early adopters in academia to making SDM and PPI standard practice.
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Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; CERPOP, Université de Toulouse, Inserm, Université Toulouse III - Paul-Sabatier, Toulouse, France
| | - Christian von Plessen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Department of Clinical Research, University of Southern Denmark, C Odense, Denmark
| | - Reto Auer
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | | | | | | | - Jacques Cornuz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
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Simons M, Rapport F, Zurynski Y, Stoodley M, Cullis J, Davidson AS. Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review. BMJ Open 2022; 12:e057335. [PMID: 35470193 PMCID: PMC9039384 DOI: 10.1136/bmjopen-2021-057335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES This scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored. DESIGN Scoping review of literature from January 2017 to June 2021. SETTING Any setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online). PARTICIPANTS Doctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway. METHODS Searches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews. RESULTS Of the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM. CONCLUSIONS SDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors' skills and patient care. PROTOCOL A protocol for this review has been published and contains further details of the methodology.
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Affiliation(s)
- Mary Simons
- Library, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Marcus Stoodley
- Macquarie Neurosurgery & Spine, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
| | - Jeremy Cullis
- Library, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew S Davidson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Neurosurgery, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
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Archuleta S, Chew N, Ibrahim H. The Value of International Research and Learning in Graduate Medical Education. J Grad Med Educ 2019; 11:1-4. [PMID: 31428250 PMCID: PMC6697296 DOI: 10.4300/jgme-d-19-00478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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