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Diouf NT, Musabyimana A, Blanchette V, Lépine J, Guay-Bélanger S, Tremblay MC, Dogba MJ, Légaré F. Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review. JMIR Med Educ 2022; 8:e42033. [PMID: 36318726 PMCID: PMC9773026 DOI: 10.2196/42033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. OBJECTIVE In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. METHODS From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. RESULTS Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. CONCLUSIONS Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.
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Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Angèle Musabyimana
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetic and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Johanie Lépine
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie-Claude Tremblay
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Maman Joyce Dogba
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Tremblay MC, Garceau L, Thiab Diouf N, Guichard A, Quinty J, Gravel C, Rheault C. Improving Understanding of Reflexivity in Family Medicine: Development of an Educational Tool Based on a Rapid Review. MedEdPublish (2016) 2021; 10:181. [PMID: 38486532 PMCID: PMC10939579 DOI: 10.15694/mep.2021.000181.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: In the last decade, reflexivity has emerged as a key concept in family medicine, as evidenced by its increasing integration in competency statements and frameworks in the field. However, the concept of reflexivity is inconsistent and ill-defined in medical education literature, with variable purposes and associated processes, which is an important barrier to learning and implementing reflective practices. This project built on the results of a rapid review to develop an educational tool supporting the learning and teaching of reflexivity in family medicine. Methods: We conducted a rapid review of quantitative, qualitative and mixed studies relating to reflexivity in family medicine between May 2007 to May 2017 in PubMed, Embase, PsychInfo, CINHAL, ERIC and Education Source. Two reviewers independently identified, selected and reviewed studies. Results of the review were used to frame the content of the tool. Results: Our research strategy initially identified 810 studies, from which 65 studies were retained for analysis. The different conceptions of reflexivity encountered in the included studies were analyzed using thematic analysis. Four conceptions of reflexivity (i.e. clinical, professional, relational and social reflexivity), with related definitions, goals and processes were identified in the included studies and were used as a basis to develop the Reflexivi-Tool. Conclusion: There is a need to provide clear guidelines regarding the purpose and process of reflexivity, as well as better equipping mentors so they can better facilitate these kinds of skills. Based on a rapid review, this study has allowed the development of a tool that presents and clarifies four main types of reflexivity for medical practice in a concise and user-friendly way. Tools such as Reflexivi-Tool are crucial to support reflective processes that target different dimensions of professionalism.
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Müller E, Strukava A, Scholl I, Härter M, Diouf NT, Légaré F, Buchholz A. Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies. BMJ Open 2019; 9:e026488. [PMID: 31230005 PMCID: PMC6596948 DOI: 10.1136/bmjopen-2018-026488] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
DESIGN AND OBJECTIVES We performed a systematic review of studies evaluating healthcare provider (HCP) trainings in shared decision-making (SDM) to analyse their evaluation strategies. SETTING AND PARTICIPANTS HCP trainings in SDM from all healthcare settings. METHODS We searched scientific databases (Medline, PsycInfo, CINAHL), performed reference and citation tracking, contacted experts in the field and scanned the Canadian inventory of SDM training programmes for healthcare professionals. We included articles reporting data of summative evaluations of HCP trainings in SDM. Two reviewers screened records, assessed full-text articles, performed data extraction and assessed study quality with the integrated quality criteria for review of multiple study designs (ICROMS) tool. Analysis of evaluation strategies included data source use, use of unpublished or published measures and coverage of Kirkpatrick's evaluation levels. An evaluation framework based on Kirkpatrick's evaluation levels and the Quadruple Aim framework was used to categorise identified evaluation outcomes. RESULTS Out of 7234 records, we included 41 articles reporting on 30 studies: cluster-randomised (n=8) and randomised (n=9) controlled trials, controlled (n=1) and non-controlled (n=7) before-after studies, mixed-methods (n=1), qualitative (n=1) and post-test (n=3) studies. Most studies were conducted in the USA (n=9), Germany (n=8) or Canada (n=7) and evaluated physician trainings (n=25). Eleven articles met ICROMS quality criteria. Almost all studies (n=27) employed HCP-reported outcomes for training evaluation and most (n=19) additionally used patient-reported (n=12), observer-rated (n=10), standardised patient-reported (n=2) outcomes or training process and healthcare data (n=10). Most studies employed a mix of unpublished and published measures (n=17) and covered two (n=12) or three (n=10) Kirkpatrick's levels. Identified evaluation outcomes covered all categories of the proposed framework. CONCLUSIONS Strategies to evaluate HCP trainings in SDM varied largely. The proposed evaluation framework maybe useful to structure future evaluation studies, but international agreement on a core set of outcomes is needed to improve evidence. PROSPERO REGISTRATION NUMBER CRD42016041623.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Strukava
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ndeye Thiab Diouf
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Diouf NT, Ben Charif A, Adisso L, Adekpedjou R, Zomahoun HTV, Agbadjé TT, Dogba MJ, Garvelink MM. Shared decision making in West Africa: The forgotten area. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2017; 123-124:7-11. [DOI: 10.1016/j.zefq.2017.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dion M, Diouf NT, Robitaille H, Turcotte S, Adekpedjou R, Labrecque M, Cauchon M, Légaré F. Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial. JMIR Med Educ 2016; 2:e17. [PMID: 27993760 PMCID: PMC5206485 DOI: 10.2196/mededu.6442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND DECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation. OBJECTIVE The objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition. METHODS We identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents' participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores. RESULTS The tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents' scores and therefore could tell us little about its effect on increasing their knowledge. CONCLUSION Residents' use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.
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Affiliation(s)
- Maxime Dion
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - Ndeye Thiab Diouf
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Community Health, Université Laval, Quebec, QC, Canada
| | - Hubert Robitaille
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Stéphane Turcotte
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Labrecque
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Cauchon
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Diouf NT, Menear M, Robitaille H, Painchaud Guérard G, Légaré F. Training health professionals in shared decision making: Update of an international environmental scan. Patient Educ Couns 2016; 99:1753-1758. [PMID: 27353259 DOI: 10.1016/j.pec.2016.06.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/18/2016] [Accepted: 06/12/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To update an environmental scan of training programs in SDM for health professionals. METHODS We searched two systematic reviews for SDM training programs targeting health professionals produced from 2011 to 2015, and also in Google and social networks. With a standardized data extraction sheet, one reviewer extracted program characteristics. All completed extraction forms were validated by a second reviewer. RESULTS We found 94 new eligible programs in four new countries and two new languages, for a total of 148 programs produced from 1996 to 2015-an increase of 174% in four years. The largest percentage appeared since 2012 (45.27%). Of the 94 newprograms, 42.55% targeted licensed health professionals (n=40), 8.51% targeted pre-licensure (n=8), 28.72% targeted both (n=27), 20.21% did not specify (n=19), and 5.32% targeted also patients (n=5). Only 23.40% of the new programs were reported as evaluated, and 21.28% had published evaluations. CONCLUSIONS Production of SDM training programs is growing fast worldwide. Like the original scan, this update indicates that SDM training programs still vary widely. Most still focus on the single provider/patient dyad and few are evaluated. PRACTICE IMPLICATIONS This update highlights the need to adapt training programs to interprofessional practice and to evaluate them.
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Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - Matthew Menear
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1V 0A6, Canada
| | - Hubert Robitaille
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - Geneviève Painchaud Guérard
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1V 0A6, Canada.
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