Blended online learning for oncologists to improve skills in shared decision making about palliative chemotherapy: a pre-posttest evaluation

Abstract

Purpose To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format. Methods A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists’ self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models. Results Oncologists (n = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists’ beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller. Conclusion Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.

Through the Eyes of Patients: The Effect of Training General Practitioners and Nurses on Perceived Shared Decision-Making Support

“…This innovative, experimental study demonstrated that cancer patients and survivors (i.e., APs) did not differentiate trained from untrained HCPs when evaluating SDM support. Although trained observers established a medium effect of the training on SDM support behavior of HCPs, 21 this effect was apparently not sufficiently large to be perceived by APs or it was not meaningful enough to them. In line, we found low correlations between assessments of trained observers and APs.…”

“…We previously conducted standardized patient assessments (SPAs) before and after a training program on SDM support for GPs and nurses. 21 The video-recorded SPAs were assessed by trained observers to evaluate the trainings’ effectiveness. In the current innovative, experimental study design, video recordings ( n = 32) of SPAs of GPs ( n = 8) and nurses ( n = 8) conducted before (SPA T0) and after (SPA T2) the training were assessed by at least 4 cancer patients or survivors ( n = 132); each participant watched 1 SPA.…”

“…In addition, the intraclass correlations between APs' assessments were calculated with 1-way random-effects models as each SPA was assessed by a different set of raters. 40 Also, correlations between APs' assessments and trained observers' assessments from the previous study 21 were calculated. Next, HCP discipline and its interaction with training status (HCP discipline 3 before/after training) were added to the LMMs to examine possible differences between GPs and nurses.…”

“…Research shows that training can strengthen SDM support knowledge and skills of HCPs. 18–21 We previously evaluated a training program in SDM support for GPs and nurses by having expert observers assess video-recorded simulated consultations conducted before and after the training. These observers established a medium-sized significant improvement in SDM support behavior after training.…”

“…These observers established a medium-sized significant improvement in SDM support behavior after training. 21 Former research, however, has shown that patients and trained observers evaluate the SDM behavior of clinicians differently. 22,23 This stresses the necessity of exploring patient perspectives.…”