Training physicians in shared decision-making—Who can be reached and what is achieved?

Bieber, Christiane; Nicolai, Jennifer; Hartmann, Mechthild; Blumenstiel, Klaus; Ringel, Nadja; Schneider, Antonius; Härter, Martin; Eich, Wolfgang; Loh, Andreas

doi:10.1016/j.pec.2009.03.019

Cited by 68 publications

(79 citation statements)

References 38 publications

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“…[7][8][9] Prior studies across multiple specialties have demonstrated that interventions to teach SDM skills can be both necessary and effective. [10][11][12][13][14] However, for SDM to be integrated into routine clinical care, those skills need to be taught and modeled routinely during training. 9 While residency programs have been reevaluating how physicians-in-training can gain the necessary skills for SDM, little is known about how contextual factors of residency or the perspectives of attending physicians affect residents' opportunities to practice these skills.…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

Schoenfeld

Goff

Elia

et al. 2018

Journal of Graduate Medical Education

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Section: Introductionmentioning

confidence: 99%

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

Schoenfeld

Goff

Elia

et al. 2018

Journal of Graduate Medical Education

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“…15,28 We are intrigued by our finding that activation of only a very few patients appeared to provide the necessary spark to ignite meaningful shared decision making. Physicians do value shared decision making in concept, 5,6 and physicians' behavior is highly sensitive to their perception of patients' expectations. 29,30 Just as physicians tend to overprescribe antibiotics when they believe that many patients want them, perhaps encountering even a few activated patients induced the perception that men in general want to participate in the decision to do prostate cancer screening and facilitated both more engagement in shared decision making and less willingness to tell the patient what to do in response to the question: "What would you do if you were me?"…”

Section: Discussionmentioning

confidence: 99%

“…3 In shared decision making, the partnership between doctor and patient facilitates the latter's understanding of pertinent medical information so as to enable him to weigh his values and preferences regarding various options and to engage in active decision making to the extent he feels comfortable. 4 Although physicians feel that shared decision making is appropriate regarding prostate cancer screening, 5,6 most primary care physicians routinely order a PSA test with little or no discussion about the patient's belief as to whether the potential benefits justify the risk of harm. [7][8][9] Insufficient understanding of epidemiological concepts or of the specific trade-offs associated with PSA screening, legal fears of deviating from standard practice, lack of time, difficulty eliciting an individual patient's values and preferences, and a perceived inability to adequately inform patients about complex decisions are barriers to shared decision making for the decision to screen for prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster Randomized Controlled Trial

Wilkes

Day

Srinivasan

et al. 2013

The Annals of Family Medicine

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BACKGROUND Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. METHODSOur study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Webbased educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening.RESULTS Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control = 38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A = 50%, MD-Ed = 33%, control = 15%; P <.05). Of the male patients, 80% had had previous PSA tests. CONCLUSIONSAlthough activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.

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“…It is unknown what factors would facilitate emergency physician interest and participation in such a course, as well as the factors that would make such a course effective for the emergency care setting. 8,11,30 Traditionally structured CME courses may not be the best methodology for teaching SDM. In SDM, both patients and physicians need access to relevant evidence to help inform a decision.…”

Section: Continuing Medical Education and Specialty Societiesmentioning

confidence: 99%

“…9 Therefore, community-based learning (CBL) models, with active partnership of healthcare professionals and community members, may enhance learning and be more effective. 8 The CBL model also incorporates an outcome of the conference itself, which is that SDM education of the public should be an emphasis of the research agenda.…”

Section: Continuing Medical Education and Specialty Societiesmentioning

confidence: 99%

The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda

Chen

Kanzaria

Itakura

et al. 2016

Academic Emergency Medicine

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Shared decision making (SDM) is a patient-centered communication skill that is essential for all physicians to provide quality care. Like any competency or procedural skill, it can and should be introduced to medical students during their clerkships (undergraduate medical education), taught and assessed during residency training (graduate medical education), and have documentation of maintenance throughout an emergency physician's career (denoted as continuing medical education). A subgroup representing academic emergency medicine (EM) faculty, residents, content experts, and patients convened at the 2016 Academic Emergency Medicine Consensus Conference on SDM to develop a research agenda toward improving implementation of SDM through sustainable education efforts. After developing a list of potential priorities, the subgroup presented the priorities in turn to the consensus group, to the EM program directors (CORD-EM), and finally at the conference itself. The two highest-priority questions were related to determining or developing EM-applicable available tools and on-shift interventions for SDM and working to determine the proportion of the broader SDM curriculum that should be taught and assessed at each level of training. Educating patients and the community about SDM was also raised as an important concept for consideration. The remaining research priorities were divided into high-, moderate-, and lower-priority groups. Moreover, there was consensus that the overall approach to SDM should be consistent with the high-quality educational design utilized for other pertinent topics in EM.

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Training physicians in shared decision-making—Who can be reached and what is achieved?

Cited by 68 publications

References 38 publications

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster Randomized Controlled Trial

The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda

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