Promoting Shared Decision-Making Behaviors During Inpatient Rounds: A Multimodal Educational Intervention

Abstract

Purpose To estimate the effectiveness of a multimodal educational intervention to increase use of shared decision-making (SDM) behaviors by inpatient pediatric and internal medicine hospitalists and trainees at teaching hospitals at Stanford University and the University of California, San Francisco. Method The 8-week Patient Engagement Project Study intervention, delivered at four services between November 2014 and January 2015, included workshops, campaign messaging, report cards, and coaching. For 12-week pre- and postintervention periods, clinician peers used the nine-point Rochester Participatory Decision-Making Scale (RPAD) to evaluate rounding teams’ SDM behaviors with patients during ward rounds. Eligible teams included a hospitalist and at least one trainee (resident, intern, medical student), in addition to nonphysicians. Random-effects models were used to estimate intervention effects based on RPAD scores that sum points on nine SDM behaviors per patient encounter. Results In total, 527 patient encounters were scored during 175 rounds led by 49 hospitalists. Patient and team characteristics were similar across pre- and postintervention periods. Improvement was observed on all nine SDM behaviors. Adjusted for the hierarchical study design and covariates, the mean RPAD score improvement was 1.68 points (95% CI, 1.33–2.03; P < .001; Cohen d = 0.82), with intervention effects ranging from 0.7 to 2.5 points per service. Improvements were associated with longer patient encounters and a higher percentage of trainees per team. Conclusions The intervention increased behaviors supporting SDM during ward rounds on four independent services. The findings recommend use of clinician-focused interventions to promote SDM adoption in the inpatient setting.

Shared Decision-making With Parents of Hospitalized Children: A Qualitative Analysis of Parents’ and Providers’ Perspectives

“…Unlike providers, who understood the process of SDM to be what is defined in the literature 1 and highlighted in SDM assessment tools [25][26][27] as an interactive and iterative approach, the majority of the parents, including both those with CMC and those with previously healthy children, instead identified the importance of providers actively listening and effectively communicating the medical condition and options. This research builds on the research of Blankenburg et al 20 and Harman et al, 21 who found a difference in parent and provider perceptions of SDM but did not identify the missing components. There was also the provider assumption that parents of CMC have more experience and knowledge in their child' s medical condition, making it easier to participate in SDM with this population.…”

“…[14][15][16][17] In previous studies, researchers have found that patient perceptions of shared decisions differ from physician perceptions of SDM. 18,19 Blankenburg et al 20 and Harman et al 21 noticed a difference in parent and provider perceptions on inpatient rounds but did not identify the reason why. Given what little is known about how to optimize SDM during a child' s hospitalization, the objective of our study was to describe parents' and their providers' perspectives on SDM during the hospitalization of their children, including facilitators and barriers, and explore differences between parents of CMC and parents of children with no chronic conditions.…”

Application Strategies of Cloud Computing Intelligent Optimization Algorithms in English Translation Major Teaching

“…ese English translations are not up to the standard, and the meaning is relatively vague [12]. After the students translate the exercises, the translation often deviates from the original meaning [13]. Students know how to translate, but they cannot express their inner thoughts correctly.…”

Interprofessional Shared Decision-Making: A Literature Review

“…39,41 In the post-graduate stage (post-licensure) SDM training is delivered in various methods and ways of delivery. Harman et al 42 developed a training program to improve the physicians' behavior towards SDM, which was conducted when doing rounds of inpatients. The training program included Patient Engagement Project (PEP) workshop on SDM, followed with a campaign of using SDM in the form of posters, pocket cards, and electronic messages as a reinforcement of previously received SDM material.…”