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

Abstract

Despite numerous initiatives to increase SDM worldwide, SDM has not yet been widely implemented in clinical practice. A key barrier to SDM is that many health professionals have not been trained with the relational and communication skills required for SDM. To support the development and implementation of SDM training programs, this paper maps the evidence in relation to SDM training programs for health professionals and students, in terms of training design and content as well as evaluation outcomes. Method:Using a systematic scoping review methodology, quantitative and qualitative evidence were systematically considered to map the literature in relation to SDM training. To identify studies, the databases PubMed, Medline and CINAHL were searched from 2009 to 2019 and reference lists of included studies were examined. Articles were reviewed for inclusion by both authors, and data was extracted using a purposely designed form. Results:The review identified 49 studies evaluating 36 unique training programs, of which 18 were for health professionals in tertiary settings, 10 in primary care and 8 for students. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 RCTs. There was considerable variation in terms of the design and duration of programs. Most programs included an overview of SDM theories and key competencies, and included SDM skill development through role plays. Few or no 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. Overall training was feasible, well received, and improved participants' knowledge and skills, but limited in its impact on patients. Conclusion:While given the diversity in training programs and evaluation methods used this review is limited in its ability to comment on which types of training programs are more effective than others, there remains a need for longer-term and more in-depth training to embed SDM in practice. Eligibility criteria As per Table 1, studies relevant to the implementation and effectiveness and of training interventions were included (see Table 1).Insert Table 1: Inclusion and Exclusion.Table 1: Inclusion and exclusion criteria Inclusion criteria Exclusion criteria Studies about the implementation and/or evaluation of SDM training for health professionals and/or students/trainees/residents, including interventions in the use of decision aids Studies about SDM training for patients only, or the implementation of SDM without a specific training program Studies in relation communication training programs that include SDM as a core component Studies in relation to communication training more broadly, without a SDM component Primary qualitative, quantitative (descriptive and analytic) and mixed method studies Literature reviews, opinion pieces Published in peer reviewed journals Non-peer reviewed studies, conference papers and study protocols Published between 2009 and March...

Teaching clinicians shared decision making and risk communication online: an evaluation study

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The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

“…To ensure that women make informed decisions about their own care, they should be provided with unbiased information about their birth options, informed by the evidence, and their own birth beliefs and preferences should be considered in the decision‐making process 49 . Clinicians may benefit from reflecting on their own beliefs and values and making them explicit to help ensure they do not inadvertently influence women toward their own birth preferences 50 . In addition, to help ensure women are provided with unbiased information, decision aids can be used to present women with the evidence in terms of risks and benefits of any intervention 51,52 .…”

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“…53 Lastly, further research is required to evaluate the effectiveness of various SDM interventions. 51 CONCLUSION Dermatologists and rheumatologists experience knowledge, skill and confidence gaps in relation to childbearing, treatment and management discussions with women of reproductive age with CID. They also experience challenges collaborating with other healthcare providers involved in the care of these patients.…”