Decision-making Training Programs Research Articles

Building Frontline Capability for Shared Decision-Making (SDM) in a Major Academic Oncology Center Caring for People With Non-Small Cell Lung Cancer: Performance Outcomes of a SDM Simulation Training Program.

There is a growing body of evidence on shared decision-making (SDM) training programs worldwide. However, there is wide variation in program design, duration, effectiveness, and evaluation in both academia (ie, medical school) and the practice setting. SDM training has been slow to integrate in practice settings. A pilot study of 6 multidisciplinary clinicians was conducted using quantitative and qualitative methods to evaluate changes in participant understanding and implementation of SDM in the practice setting. A 2-rater criterion-based evaluation method was used to assess a simulation-based case study role-play program using 7 domains of SDM pre and post training. The authors assessed whether clinicians addressed each of the 7 domains or what fraction of each domain was addressed as part of their simulation case study role-play performance. Focus groups were conducted pre- and postintervention to provide feedback to participants and to understand the clinician experience in greater detail. The increase in improvement in SDM ranged from 17% to 37%, and 7 of 8 domains for which participants were rated showed significant improvement. The areas of greatest improvement were seen in determining a patient's goals/preferences, including risk tolerance regarding treatments (+37%) and values and self-efficacy (+37%). The results of this study reveal a significant shift in clinician awareness of a patient's goals, preferences, and values. Postintervention, clinicians began to understand the value of building a partnership with their patients whereby the patient becomes an active participant in their clinical care.

Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care.

Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. PRR1-10.2196/53150.

The Training Curriculum is Based on the Problem Solving and Decision Making Blended Learning to Improve the Employees’ Soft Skills

The objective of this study is to develop a training curriculum design based on the problem solving & decision-making blended learning to improve the employees’ soft skills. The specific objectives of this study are 1) to determine the need for Problem Solving & Decision-Making competencies based on the results of training needs analysis; 2) to determine the training curriculum design based on the problem solving & decision-making blended learning to improve employees’ soft skills; and 3) to determine the result of expert judgments in relation to the training curriculum design. The study uses a design and development research approach and curriculum validation of expert judgment. The results of this study are as follows: 1) based on the training needs analysis, the data gathered shows that the employees’ current competency in solving problems and decision-making is not in accordance with the current Problem Solving & Decision-Making training program. 2) The parts developed in the Problem Solving & Decision-Making curriculum include the structure of curriculum components covering the training objective, training material, training hours, learning process both on the methods and media used, and evaluation on the program. 3) Based on the results of expert judgements on the training curriculum on aspects of objectives, material, process, and evaluation, the average assessment result is "Good".

Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review.

Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.

Implementation of a shared decision-making training program for clinicians based on the major depressive disorder guidelines in Japan: A multi-center cluster randomized trial.

BackgroundAlthough shared treatment decision-making with patients requires attention, it is not widely implemented, particularly in the field of psychiatry. The aim of this study was to assess whether a shared decision-making (SDM) training program for clinicians based on the major depressive disorder (MDD) guidelines improved the perceived involvement of the decision process for patients with MDD.MethodsA multi-center cluster-randomized controlled intervention of a clinician training program based on the Japanese MDD guidelines using related decision aids compared to usual care was conducted among 56 clinicians from 23 institutions. A total of 124 patients with MDD were enrolled in this study. The primary outcomes were the scores of the Shared Decision Making-Questionnaire-9 (SDM-Q-9) and Decision Conflict Scale (DCS) after the first visit to the outpatient clinics. The secondary outcomes were patients’ satisfaction, quality of life, trust in clinicians, and depressive symptoms. Additionally, we evaluated all the observed outcomes at the first and third months of follow-up.ResultsThe scores of the SDM-Q-9 in the SDM training program group were significantly higher than those in the control group at the first visit. However, no significant difference in the DCS scores was found between the two groups. There was no intervention effect for secondary outcomes and the outcomes at the first- and third-month follow-up visits.ConclusionThe clinician training program based on the Japanese MDD guidelines can be useful for implementation of SDM. Additional research is needed to confirm the efficacy of this SDM training program.Clinical trial registration[https://www.umin.ac.jp/], identifier [UMIN000034397].

Effectiveness of interprofessional shared decision-making training: A mixed-method study

ObjectiveThis study evaluated the learning effects and examined the participants’ perceptions of an interprofessional shared decision-making (IP-SDM) training program. MethodsThis mixed-method study used a quasi-experimental pretest–posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb’s experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules. ResultsA total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners’ attitude, knowledge, skills, and teamwork. ConclusionThis IP-SDM training program improved multidisciplinary healthcare personnel’s competency, self-efficacy, and intention to engage in IP-SDM. Practice implicationsApplying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel’s knowledge, attitude, skills, and teamwork in IP-SDM.

Web-Based Training for Nurses on Using a Decision Aid to Support Shared Decision-making About Prenatal Screening: Parallel Controlled Trial.

BackgroundNurses play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision-making (SDM) training program for health professionals focusing on Down syndrome screening decisions.ObjectiveIn this study, we aim to assess the impact of an SDM training program on nurses’ intention to use a decision aid with pregnant women deciding on prenatal screening for Down syndrome.MethodsIn this 2-arm, parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was the intention to use a decision aid. Secondary outcomes were psychosocial variables of intention, knowledge, satisfaction, acceptability, perceived usefulness, and reaction to the pedagogical approach. All outcomes were self-assessed through web-based questionnaires, including the space for written comments. We used 2-tailed Student t test and Fisher exact test to compare continuous and categorical variables between groups, respectively.ResultsOf the 57 participants assessed for eligibility, 40 (70%) were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. The mean age of the participants was 41 (SD 9) years. Most were women (39/40, 98%), White (38/40, 95%), clinical nurses (28/40, 70%), and had completed at least a bachelor’s degree (30/40, 75%). After the intervention, the mean score of intention was 6.3 (SD 0.8; 95% CI 5.9-6.7) for the intervention group and 6.0 (SD 1.2; 95% CI 5.42-6.64) for the control group (scale 1-7). The differences in intention and other psychosocial variable scores between the groups were not statistically significant. Knowledge scores for SDM were significantly higher in the intervention group (79%, 95% CI 70-89 vs 64%, 95% CI 57-71; P=.009). The intervention was significantly more acceptable in the intervention group (4.6, 95% CI 4.4-4.8 vs 4.3, 95% CI 4.1-4.5; P=.02), and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7, 95% CI 4.5-4.8 vs 4.4, 95% CI 4.2-4.5; P=.02). There was no significant difference in overall satisfaction (or in perceived usefulness). Furthermore, 17 participants (9 in the intervention group and 8 in the control group) provided written comments on the intervention.ConclusionsThis study focuses on web-based nursing education and its potential to support pregnant women’s decision-making needs. It shows that nurses’ intention to use a decision aid to enhance SDM in prenatal care is high, with or without training, but that their knowledge about SDM can be improved with web-based training.International Registered Report Identifier (IRRID)RR2-10.2196/17878

Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes - relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort - provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.

Relationship Between Basic Human Values and Decision-Making Styles in Adolescents.

This paper examines the relationship between decision-making styles and values of Spanish adolescents and analyses the role of age and gender on their use of adaptive and maladaptive decision-making styles. The scientific literature suggests that decision-making consists of different stages through which individuals reach a solution to their dilemmas. An ex post facto quantitative, non-experimental research design was used and applied to a sample of adolescents of Madrid (España). The Flinders Adolescents Decision-Making Questionnaire (FADMQ) by Mann as well as the Schwartz Values Scale (SVS) were also used. Correlation analysis was used to analyze the decision-making styles and values of adolescents using the variables gender and age to classify the sample. The study concludes that adolescents who use an adaptive decision-making style tend to pursue mastery of the values Self-direction, Stimulation, Achievement, and Power, whereas adolescents who use a maladaptive style tend to shy away from the value Self-direction and are more conservative. In terms of gender, the results for both females and males coincide in the significant correlations found between their decision-making styles and values. In terms of age, the correlations between values and decision-making styles are higher and numerous in younger adolescents. We conclude that the relationships verified could help educators to engage and act on the development of specific decision-making training programs based on the values of adolescents.

Decision-Making in Youth Team-Sports Players: A Systematic Review.

The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between low- and high-level youth players; (ii) analyze the variations of decision-making processes between different age groups; and (iii) analyze the effects of decision-making training-based programs on youth players. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, this systematic review searched for studies on PubMed, ScienceDirect, Academic Search Complete, SPORTDiscus, and Taylor & Francis Online. The search returned 6215 papers. After screening the records against set criteria, 26 articles were fully reviewed. From the included studies, 9 were focused on comparing the decision-making process between low- and high-level players, 6 compared the decisions made by players from different age categories, and 11 analyzed the effects of decision-making-based training programs on youth players. Comparisons between high- and low-level players suggested that high-level and most talented players present a greater accuracy in the cognitive and executive answers to the game as well as being more adjustable to more complex situations. Considering the comparisons between age groups, a tendency of older players to execute more accurate decisions in the game and to have better tactical knowledge and behavior was observed. Finally, the effects of decision-making training programs suggest a beneficial effect employing practical scenarios (mainly based on small-sided and conditioned games), primarily improving passing decisions and execution. However, the benefits of interventions using videos are not clear.

Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review.

To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.

The Impact of a Shared Decision-Making Training Program on Dementia Care Planning in Long-Term Care.

Shared decision-making (SDM) can be a way for staff to adopt international recommendations advocating the involvement of nursing home residents and their family members in care planning and the development of personalized care plans. The main aim was to analyze the effects of training nursing home staff in the implementation of SDM on agreement of residents' 'life-and-care plans' with the recommendations (primary outcome) and on family caregivers' quality of life and sense of competence, and staff's job satisfaction (secondary outcomes). In the intervention condition, staff attended a training program on the use of SDM with residents and family caregivers in the care planning process. In the control condition, care planning as usual took place. For the primary outcome, in-depth qualitative and quantitative analyses of the care plans were performed. Multivariate Permutation Tests were applied to assess the impact on secondary outcomes. Forty-nine residents and family caregivers and 34 professionals were involved. Overall, many of the care plans developed during the intervention showed a high level of agreement with the care planning recommendations. Both Italian and Dutch care plans showed improvement in the number of clear problem statements (p < 0.001). In Italy, significant improvements (p < 0.05) were also found regarding specific care objectives, documentation of objectives met, and of residents and families' involvement. No impact was found on secondary outcomes. The involvement of residents and family caregivers in care planning contributed to an improvement of the residents' care plans, but it did not have an effect on family caregivers and staff outcomes.

A PKM–Based Decision-Making Training Program for Personal Healthcare

Making effective healthcare decisions is important. Despite the large volumes of information available, individuals often face limitations evaluating this information and making effective decisions. This article reports on the design, implementation and evaluation of a pilot training program based on action learning principles. The evaluation of the pilot program provided a clear understanding of what needed to be refined in terms of program structure, content and delivery. Participants' experience of the PKM process was also gained. The results of the study are expected to contribute to knowledge management in three ways: 1) inform current and future researchers of PKM in individual healthcare decision-making; 2) provide a PKM training model for individual healthcare decision-making; 3) demonstrate how action learning can be linked with a training program for the purposes of collecting research data.

Blueprint for scaling advance care planning conversations to medical practices

Summary Establishment of the Community Conversations initiative in Schenectady County, New York began as a response to pleas from palliative care professionals who recognized the absence or paucity of Advance Directives (AD) in the medical records of referred patients. The palliative care physicians responsible for cases of the critically ill or those with diminished or no decisional capacity often faced the challenging task of locating a previously prepared AD, if any, identifying a healthcare proxy or agent who could speak on behalf of the patient (in terms of best interests or substituted judgment), or identifying clear and convincing evidence as to what, if any, life-sustaining treatment was expressed prior to illness. Practitioners and patients, both in the US and France, have historically avoided the confrontation and “the conversation.” Similarly, examination of shared decision making training programs evidenced wide variations in how and what they deliver. More importantly, evidence of their effectiveness was sparse. Studies on shared decision making programs suggest there is a need for international consensus on ways to address the variability in patient-centered programs concerning “the conversation” surrounding Advance Care Planning (ACP).

Prostate Cancer Ambassadors: Process and Outcomes of a Prostate Cancer Informed Decision-Making Training Program

Prostate Cancer Ambassadors: Process and Outcomes of a Prostate Cancer Informed Decision-Making Training Program

Prostate Cancer Ambassadors: Process and Outcomes of a Prostate Cancer Informed Decision-Making Training Program.

African American men bear a higher burden of prostate cancer than Caucasian men, but knowledge about how to make an informed decision about prostate cancer screening is limited. A lay health advisor model was used to train "Prostate Cancer Ambassadors" on prostate cancer risk and symptoms, how to make an informed decision for prostate-specific antigen screening, and how to deliver the information to members of their community. Training consisted of two, 6-hour interactive sessions and was implemented in three predominantly African American communities over an 8-month period between 2013 and 2014. Following training, Ambassadors committed to contacting at least 10 people within 3 months using a toolkit composed of wallet-sized informational cards for distribution, a slide presentation, and a flip chart. Thirty-two Ambassadors were trained, with more than half being females (59%) and half reporting a family history of prostate cancer. Prostate cancer knowledge improved significantly among Ambassadors ( p ≤ .0001). Self-efficacy improved significantly for performing outreach tasks ( p < .0001), and among women in helping a loved one with making an informed decision ( p = .005). There was also an improvement in collective efficacy in team members ( p = .0003). Twenty-nine of the Ambassadors fulfilled their commitment to reach at least 10 people (average number of contacts per Ambassador was 11). In total, 355 individuals were reached with the prostate cancer information. The Ambassador training program proved successful in training Ambassadors to reach communities about prostate cancer and how to make an informed decision about screening.

Effectiveness of Shared Decision-Making Training Program in People With Schizophrenia in South Korea

This study aimed to investigate the effects of shared decision-making (SDM) training program on self-esteem, problem-solving ability, and quality of life in people with schizophrenia. A quasi-experiment with a nonequivalent control group pre-posttest design was conducted. The self-esteem scale, the problem-solving ability scale, and the WHOQOL Scale were used. The SDM training program was effective in improving their self-esteem, problem-solving ability, and quality of life in people with schizophrenia. The SDM training program can be used in various mental health fields such as hospitals, mental health centers, and rehabilitation facilities.

Note on a Training Program for Brief Decision Making for Frontline Police Officers

Purpose The present paper describes the theoretical basis for a brief decision-making training program for frontline police officers as well as an outline of the training program, officers’ evaluation of perceived relevance and perceived learning effects.

Development and field testing of a consumer shared decision-making training program for adults with low literacy

ObjectiveGiven the scarcity of shared decision-making (SDM) interventions for adults with low literacy, we created a SDM training program tailored to this population to be delivered in adult education settings. MethodsFormative evaluation during program development included a review of the problem and previous efforts to address it, qualitative interviews with the target population, program planning and field testing. ResultsA comprehensive SDM training program was developed incorporating core SDM elements. The program aimed to improve students’ understanding of SDM and to provide them with the necessary skills (understanding probabilistic risks and benefits, personal values and preferences) and self-efficacy to use an existing set of questions (the AskShareKnow questions) as a means to engage in SDM during healthcare interactions. ConclusionsThere is an ethical imperative to develop SDM interventions for adults with lower literacy. Generic training programs delivered direct-to-consumers in adult education settings offer promise in a national and international environment where too few initiatives exist. Practice implicationsFormative evaluation of the program offers practical insights into developing consumer-focused SDM training. The content of the program can be used as a guide for future efforts to engage consumers in SDM.

The effect of the solution-focused decision-making training program on the vigilant decision-making of university students

The effect of the solution-focused decision-making training program on the vigilant decision-making of university students