Skip to main content

Advertisement

Log in

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

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

REFERENCES

  1. Charles C, Gafni A, Whelan T. Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Patient Educ Couns. 1999;49:651–661.

    CAS  Google Scholar 

  2. Guyatt G, Montori VM. Progress in evidence-based medicine. JAMA. 2008;300:1814–1816.

    Article  PubMed  Google Scholar 

  3. Barratt A. Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient Educ Couns. 2008;73:407–412.

    Article  PubMed  Google Scholar 

  4. Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73:526–535.

    Article  PubMed  Google Scholar 

  5. Stiggelbout A, Van der Weijden T, De Wit M, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:e256.

    Article  CAS  PubMed  Google Scholar 

  6. Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. NEJM. 2012;366:780–781.

    Article  CAS  PubMed  Google Scholar 

  7. Alston C, Paget L, Halvorson G, et al. Communicating with patients on health care evidence. Discussion paper. Washington, DC: 2012.

  8. Elwyn G, Edwards A, Hood K, et al. Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. Fam Pract. 2004;21:337–346.

    Article  CAS  PubMed  Google Scholar 

  9. Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2010;5:Art. No.: CD006732. DOI: 10.1002/14651858.CD006732.

  10. Légaré F, Bekker H, Desroches S, et al. How can continuing professional development better promote shared decision-making? Perspectives from an international collaboration. Implement Sci. 2011;6:68.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Towle A, Godolphin W, Grams G, Lamarre A. Putting informed and shared decision making into practice. Health Expect. 2006;9:321–332.

    Article  PubMed  Google Scholar 

  12. Meats E, Heneghan C, Crilly M, Glasziou P. Evidence-based medicine teaching in UK medical schools. Med Teach. 2009;31:332–337.

    Article  PubMed  Google Scholar 

  13. Hatala R, Guyatt G. Evaluating the teaching of evidence-based medicine. JAMA. 2002;288:1110–1112.

    Article  PubMed  Google Scholar 

  14. Green M. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: A critical review of curricula. Acad Med. 1999;74:686–694.

    Article  CAS  PubMed  Google Scholar 

  15. Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5:1.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Von Fragstein M, Silverman J, Cushing A, Quilligan S, Salisbury H, Wiskin C. UK consensus statement on the content of communication curricula in undergraduate medical education. Med Educ. 2008;42:1100–1107.

    Article  Google Scholar 

  17. Liaison Committee on Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the M.D. degree. June 2013. Available at: http://www.lcme.org/publications/functions.pdf Accessed Dec 27, 2013.

  18. Hauer K, Fernandez A, Teherani A, Boscardin C, Saba G. Assessment of medical students’ shared decision-making in standardized patient encounters. J Gen Intern Med. 2011;26:367–372.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Hoffmann T, Tooth L. Talking with clients about evidence. In: Hoffmann T, Bennett S, Del Mar C, eds. Evidence-based practice across the health professions. Sydney: Elsevier Inc; 2010:276–299.

    Google Scholar 

  20. Epstein RM, Alper BS, Quill TE. Communicating evidence for participatory decision making. JAMA. 2004;291:2359–2366.

    Article  CAS  PubMed  Google Scholar 

  21. Elwyn G, Hutchings H, Edwards A, et al. The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expect. 2005;8:34–42.

    Article  PubMed  Google Scholar 

  22. Siriwardena AN, Edwards AG, Campion P, Freeman A, Elwyn G. Involve the patient and pass the MRCGP: investigating shared decision making in a consulting skills examination using a validated instrument. Br J Gen Pract. 2006;56:857–862.

    PubMed Central  PubMed  Google Scholar 

  23. Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. Shared decision making: developing the OPTION scale for measuring patient involvement. Qual Saf Health Care. 2003;12:93–99.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Shepherd HL, Barratt A, Trevena LJ, et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: a cross-over trial. Patient Educ Couns. 2011;84:379–385.

    Article  PubMed  Google Scholar 

  25. Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor–patient congruence on satisfaction. Patient Educ Couns. 2000;39:49–59.

    Article  CAS  PubMed  Google Scholar 

  26. Shaw WS, Woiszwillo MJ, Krupat E. Further validation of the Patient–Practitioner Orientation Scale (PPOS) from recorded visits for back pain. Patient Educ Couns. 2012;89:288–291.

    Article  PubMed  Google Scholar 

  27. Krupat E, Yeager CM, Putnam S. Patient role orientations, doctor-patient fit, and visit satisfaction. Psychol Health. 2000;15:707–719.

    Article  Google Scholar 

  28. McKenna K, Tooth L. Client education: a partnership approach for health practitioners. Sydney: UNSW Press; 2006.

    Google Scholar 

  29. Sonntag U, Wiesner J, Fahrenkrog S, Renneberg B, Braun V, Heintze C. Motivational interviewing and shared decision making in primary care. Patient Educ Couns. 2012;87:62–66.

    Article  PubMed  Google Scholar 

  30. Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R. Efficacy of a cancer research UK communication skills training model for oncologists: a randomized controlled trial. Lancet. 2002;359:650–656.

    Article  PubMed  Google Scholar 

  31. Helitzer DL, Lanoue M, Wilson B, De Hernandez BU, Warner T, Roter D. A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Educ Couns. 2011;82:21–29.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Salzburg statement on shared decision making. BMJ. 2011;342:d1745.

  33. Berkhof M, Van Rijssen H, Schellart AJM, Anema JR, Van der Beek AJ. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ Couns. 2011;84:152–162.

    Article  PubMed  Google Scholar 

  34. Han P, Joekes K, Elwyn G, Mazor K, Thomson R, Sedgwick P, et al. Development and evaluation of a risk communication curriculum for medical students. Patient Educ Couns. 2014;94:43–49.

    Article  PubMed  Google Scholar 

Download references

Contributors

The authors thank the students who participated in the study, staff at both universities (Sandy Brauer, Robert Nee, Chrissy Erueti, Charles Leduc, Carina Doyle) who assisted with conducting the trial, and Prof Paul Glasziou (Professor of Evidence-Based Medicine, Centre for Research in Evidence-Based Practice) for his helpful comments on the manuscript.

Funders

TH is supported by a National Health and Medical Research Council of Australia (NHMRC)/Primary Health Care Research Evaluation and Development Career Development Fellowship (number: 1033038) with funding provided by the Australian Department of Health and Ageing. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. No specific funding was received to conduct this trial.

Prior Presentations

This paper was presented at the Cochrane Colloquium in Auckland, New Zealand in October 2012 and at the inaugural International Evidence-Based Health Care Conference in New Delhi, India in October 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tammy C. Hoffmann PhD.

Additional information

Trial registration: ACTRN12610000685011

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 16.2 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoffmann, T.C., Bennett, S., Tomsett, C. et al. Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial. J GEN INTERN MED 29, 844–849 (2014). https://doi.org/10.1007/s11606-014-2765-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-014-2765-5

KEY WORDS

Navigation