Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians

Abstract

BackgroundAlthough research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians.MethodsA three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians’ general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online.ResultsSeventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient’s preferred role in making the decision (62.5% very confident) and exploring a patient’s values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future.ConclusionsA comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients’ desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6947-14-95) contains supplementary material, which is available to authorized users.

Key components of shared decision making models: a systematic review

“…Twelve SDM-models were generic (ie, specified as such or no healthcare setting specified) 5 13–23. The other 28 SDM-models had been developed for a particular healthcare setting or patient group, namely primary care,24–29 screening,30 31 the inpatient setting,32 paediatrics,33–35 mental healthcare,36–38 emergency care,39 40 oncology care,41 42 chronic care,43 44 nursing care,45 physical therapy,46 older patients,47 48 serious illness,49 50 or diabetes 51…”

“…Thirteen models were focused more or less explicitly on treatment decision making,14 17 28 34 36 38 41–43 46 48 49 51 two on screening,30 31 one on test and treatment decision making,50 one on disease prioritisation and treatment,44 one on goals and actions,27 and one on decisions regarding diagnostic testing, treatment, or follow-up 19. For the other 21 models, the authors did not explicitly state the type of decision 5 13 15 16 18 20–26 29 32 33 35 37 39 40 45 47…”

“…Online supplementy appendix B shows that especially the models of Charles,17 49 Towle,16 Elwyn,14 29 and Makoul5 informed other SDM-models. Two-thirds of the models (26/40) were further or solely based on analytical thinking of the authors (ie, no data were collected in patients and/or healthcare professionals with the purpose to inform the model); of note, empirical data collected for other purposes may have informed these models 5 14 15 17 19 21 22 24 28 30–35 38–41 43–46 48–50. The development of the other models (14/40) was informed by empirical data gathered with the purpose to inform the model 13 16 18 20 23 25–27 29 36 37 42 47 51.…”

“…Three models identified the patient and several healthcare professionals as actors,25 26 30 three models identified the underaged patient, the parent, and the healthcare professional as actors 33 35 38. Ten models identified solely the healthcare professional as actor 14 21 23 24 29 32 37 39–41…”

On how to define and measure SDM

“…In this way they identified three domains not present in the three selected coding schemes: emotional environment of the encounter, clinician use of clear language, and recommendations. Partnership between clinicians and patients [6][7][8], the use of clear language [9][10][11] and checking patient understanding [8,9,12,13], and the provision of recommendations [9][10][11][13][14][15][16], are part of existing SDM definitions. Yet, based on a bottom-up approach it cannot be determined whether these domains are SDM domains.…”