Evaluation of a shared decision-making communication skills training for physicians treating patients with asthma: a mixed methods study using simulated patients

Abstract

Background Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. Methods A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION 5 , the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. Results Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION 5 : t (26) = − 5.16; p < 0.001) (SDM-Q-Doc: t (26) = − 4.39; p < 0.001) (SDM-Q-9: t (26) = − 5.86; p < 0.001). The qualitative evaluation showed that most physicians experienced a change in attitude and behavior after the training, and positively appraised the training program. Physicians considered simulated patient consultations, including feedback and video analysis, beneficial and suggested the future use of real patient consultations. Conclusion The SDM communication skills training for physicians treating patients with asthma has potential to improve SDM performance, but would benefit from using real patient consultations.

Ready for SDM: evaluating a train-the-trainer program to facilitate implementation of SDM training in Norway

“…However, evaluations covering the entire spectrum are rare. Assessing the program's impact on patient involvement in decisionmaking will be of particular importance in the broader context of the literature on SDM trainings [41] and TTT in general [42][43][44][45].…”

“…Evaluating trainers' (ambassadors) learning outcomes and behaviours (rather than the trainee/patient variables) is a unique [40] although reasonable strategy, as suggested by a recent review [42] and the Kirkpatrick Model [27]. As part of the development process [24], this approach may lead to a better understanding about the best way to support trainers in training others, and a better understanding of the development of trainers' learning abilities and behaviour over time [41]. Our recruitment strategy resulted in a mix of participants who had been sent by their hospital trusts and participants who came of their own volition.…”

“…Thirdly, to the best of our knowledge, the Ready for SDM program is the first of its kind to provide evaluated TTT methods. There is only one other evaluated TTT program in the field of SDM [46], but none in Norway [5,41,42]. Fourthly, in order to resolve the challenge of maintaining training quality when passing it along, Ready for SDM certifies trainers in an SDM training quality collaborative [47].…”

Shared decision making, physicians’ explanations, and treatment satisfaction: a cross-sectional survey of prostate cancer patients

“…Driever et al [ 29 ] reported that 31.0% made a decision using a paternalistic approach because they perceived that it was difficult for patients to make a decision, indicating that physicians and other healthcare professionals may create a barrier to SDM. To overcome such barrier, it is necessary to provide SDM communication skill training [ 30 ] and develop patient decision aids for Japanese patients, which are assistive tools that promote SDM.…”

Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent

“…61 Shared decisionmaking communication skills training courses for health-care providers have been developed, although their effectiveness is still underresearched and their implementation still insufficient. 60,62,63 Shared decision-making tools have also been developed for dsd conditions such as CAIS and CAH, and their generalizability and applicability need to be researched. 64,65 As we have to deal with controversies and knowledge gaps, matters of handling risk and uncertainty 66 and ways of dealing with specific dilemmas 41,67 play a crucial role.…”