What are the links between evidence-based medicine and shared decision-making in training programs for junior doctors? A scoping review protocol

Simons, Mary; Rapport, Frances; Zurynski, Yvonne; Cullis, Jeremy; Davidson, Andrew

doi:10.1136/bmjopen-2020-037225

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…When residents talked about the "best" treatment, they invariably based this on recommendations from evidence-based guidelines. It has been argued that good care involves the integration of EBM and patient centered communication (PCC) skills to make the best decisions for individual patients [16,33,34]. Although the founding fathers of the EBM movement emphasized that evidence-based practice implies the integration of the best available medical evidence, the physician's expertise and the patient's views and preferences [35], the guidelines are commonly presented to medical students and junior doctors as the "single best answer" and the "correct thing to do" [14,36,37], which discourages physicians from making decisions tailored to the individual patient's context, views and preferences [14,16,33].…”

Section: Discussionmentioning

confidence: 99%

Why do medical residents prefer paternalistic decision making? An interview study

et al. 2022

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Background Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their ‘paternalism preference’ are unknown, this study explored residents’ views on the decision-making process in medical encounters and the factors affecting it. Methods We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019–2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved. Results Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors’ recommendations) and by limitations in their medical and shared decision-making knowledge. The residents’ decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available. Conclusions Residents’ decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician’s treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents’ perceptions and convictions regarding their role in the decision-making process in consultations.

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Section: Discussionmentioning

confidence: 99%

Why do medical residents prefer paternalistic decision making? An interview study

et al. 2022

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“…Search strategies and documentation followed those set out in the protocol 1. However, since publication of the protocol, a new Medical Subject Heading (MeSH) term for ‘shared decision-making’ was released for Medline.…”

Section: Methodsmentioning

confidence: 99%

“…Evidence-based medicine (EBM) and shared decision-making (SDM) have been reported as interrelated aspects of patient-centred care,1–3 but they appear to be taught and reported separately in the international literature on postgraduate training of recently qualified doctors (which we describe as ‘doctors in training’ in this paper).…”

Section: Introductionmentioning

confidence: 99%

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

et al. 2022

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ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.DesignScoping review of literature from January 2017 to June 2021.SettingAny setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).ParticipantsDoctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.MethodsSearches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews.ResultsOf the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM.ConclusionsSDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors’ skills and patient care.ProtocolA protocol for this review has been published and contains further details of the methodology.

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“…Such questions may not reflect the priorities of the patient, or indeed address elements of the patient experience or barriers to their treatment or what best leads to satisfying outcomes. Such failures in seeking patient focussed data are not unique to hernia surgery (2). However, patient focussed priorities are a key part of the GRADE approach in writing the clinical guidelines (3).…”

Section: Introductionmentioning

confidence: 99%

Patient Views Around Their Hernia Surgery: A Worldwide Online Survey Promoted Through Social Media

East

Hill²,

Dames³

et al. 2021

Front. Surg.

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Introduction: Hernias are one of the most common surgical diagnoses, and general surgical operations are performed. The involvement of patients in the decision making can be limited. The aim of this study was to explore the perspectives of patients around their hernia and its management, to aid future planning of hernia services to maximise patient experience, and good outcomes for the patient.Methods: A SurveyMonkey questionnaire was developed by patient advocates with some advice from surgeons. It was promoted on Twitter and Facebook, such as all found “hernia help” groups on these platforms over a 6-week period during the summer of 2020. Demographics, the reasons for seeking a hernia repair, decision making around the choice of surgeon, hospital, mesh type, pre-habilitation, complications, and participation in a hernia registry were collected.Results: In total, 397 questionnaires were completed in the study period. The majority of cases were from English speaking countries. There was a strong request for hernia specialists to perform the surgery, to have detailed knowledge about all aspects of hernia disease and its management, such as no operation and non-mesh options. Chronic pain was the most feared complication. The desire for knowledge about the effect of the hernia and surgery on the sexual function in all age groups was a notable finding. Pre-habilitation and a hernia registry participation were well-supported.Conclusions: Hernia repair is a quality of life surgery. Whether awaiting surgery or having had surgery with a good or bad outcome, patients want information about their condition and treatment, such as the effect on aspects of life, such as sex, and they wish greater involvement in their management decisions. Patients want their surgery by surgeons who can also manage complications of such surgery or recommend further treatment. A large group of “hernia surgery injured” patients feel abandoned by their general surgeon when complications ensue.

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What are the links between evidence-based medicine and shared decision-making in training programs for junior doctors? A scoping review protocol

Cited by 6 publications

References 20 publications

Why do medical residents prefer paternalistic decision making? An interview study

Why do medical residents prefer paternalistic decision making? An interview study

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

Patient Views Around Their Hernia Surgery: A Worldwide Online Survey Promoted Through Social Media

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