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

Robert J Volk,Robert J Bulik,Richard M Wexler,Viola B Leal,Navkiran K Shokar,Gurjeet S Shokar,Suzanne K Linder,Patricia Dolan Mullen

doi:10.1186/1472-6947-14-95

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.

Highlights

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
Ratings of confidence in performing the SDM behaviors and plans to perform SDM behaviors with patients in the future were included in the evaluation, they do not provide a direct assessment of the behavior level
We previously showed that primary care physicians use a variety of practice styles related to prostate cancer screening, some of which are more consistent with the SDM approach and the use of patient decision aids [26]

Summary

Introduction

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. Eliciting patients’ values and preferences have been advocated as a vital component of the process of evidence-based clinical decision making [4] by the Institute of Medicine (IOM) [5] and by the Patient-Centered Outcomes Research Institute (http://pcori.org). Research suggests that patients prefer a SDM approach in healthcare decisions [7] and, at the least, want to be informed about their healthcare decisions [8,9], physicians do not routinely implement SDM into their practice [10,11,12]. The IOM goal of a health care system that promotes a fully informed patient participating in SDM with a health care provider remains to be realized [13]

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