Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

Abstract

BACKGROUND: Shared decision making is a crucial component of evidence-based practice, but a lack of training in the "how to" of it is a major barrier to its uptake. OBJECTIVE: To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians. DESIGN: Multi-centre randomized controlled trial. PARTICIPANTS: One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities. INTERVENTION:The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills. MAIN MEASURES: The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays. Secondary outcomes: confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS)). KEY RESULTS: Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference=18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference=0.9, 95 % CI 0.5 to 1.3), confidence measure (difference=13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference=0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale. CONCLUSIONS: This brief intervention was effective in improving student clinicians' ability, attitude towards, and confidence in shared decision making facilitation.Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training. INTRODUCTIONWhile various definitions abound, the core tenets of shared decision making include: a two-way exchange of information between the patient and clinician, discussion and deliberation of the possible options and their outcomes, and the clinician and patient both participating in the decision making process and arriving at a decision. 1 Successful evidence-based practice requires clinicians to incorporate patient values and preferences and utilise shared decision making. 2 Indeed, shared decision making can be viewed as a prerequisite to evidencebased practice. 3 However, shared decision making has not been routinely adopted by health professionals. There are barriers to its implementation. 4 One barrier is simply the lack of teaching clinicians the "how to". Recent commentaries about shared de...

Prática centrada no cliente na reabilitação: definição, instrumentos e desafios

“…A tematização destas questões, assim como o treinamento clínico prático sob princípios da PCC, deve fazer parte da formação profissional. Mesmo intervenções educativas curtas (de poucas horas e, portanto mais facilmente incorporadas a currículos já estruturados) podem produzir resultados positivos nas habilidades e crenças sobre compartilhamento de decisões entre estudantes das profissões de saúde 21 . Em relação às barreiras no nível dos pacientes, problemas cognitivos, de expressão, de memória e de autopercepção são as mais frequentemente relatadas 22 .…”

“…A implantação da PCC exige mudança na cultura das organizações e das profissões de saúde. Há diversos instrumentos de avaliação que podem ser usados para caracterizar o grau de "centralidade" no cliente, tanto no nível institucional, quanto no nível dos profissionais e dos pacientes individualmente 21,[23][24][25] . Por último, a formação de profissionais envolve investimentos financeiros, mas ao longo do tempo, os benefícios podem ultrapassar os custos 19 .…”

For the General Internist: A Summary of Key Innovations in Medical Education

“…This was a two-institution, single-blinded randomized study, with 100 (93 % of eligible) interprofessional participants, including third-year medical students, final-year occupational therapy honors students, and postgraduate physiotherapy students. 10 Both study arms received a book chapter on shared decision making, and the intervention group additionally received a 1-h tutorial that included a five-step framework for communicating evidence and a facilitated critique of a pre-recorded modeled role-play on shared decision making. Two weeks later, all participants were paired and videotaped while performing role-plays of a physician-patient encounter that required evidence-based decision making.…”

Capsule Commentary on Hoffman et al., Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Control Trial

“…1 Since then, more than 80 randomized trials have been published, many demonstrating that involving the patient in decisions and improving provider communication are associated with positive healthcare quality markers and overall morbidity and mortality outcomes. 2 Few have involved multi-disciplinary practitioners; the trial by Hoffman et al 3 evaluated the effectiveness of a brief intervention on facilitating shared decision making (SDM) among student clinicians (of medicine, physiotherapy and occupational therapy) from two Australian universities.Based on valid, objective measures of video recorded interactions with simulated patient encounters, they found that their intervention improved performance of student healthcare providers in several important outcomes, including SDM communication skills, self-confidence in SDM skills, SDM attitudes and involving patients in decision making. An important limitation of this study is that it is based on simulated patients rather than live patients and the impact of the intervention was measured shortly after the intervention.…”

“…1 Since then, more than 80 randomized trials have been published, many demonstrating that involving the patient in decisions and improving provider communication are associated with positive healthcare quality markers and overall morbidity and mortality outcomes. 2 Few have involved multi-disciplinary practitioners; the trial by Hoffman et al 3 evaluated the effectiveness of a brief intervention on facilitating shared decision making (SDM) among student clinicians (of medicine, physiotherapy and occupational therapy) from two Australian universities.…”