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.

Q2 Social Sciences
The Permanente journal Pub Date : 2024-09-16 Epub Date: 2024-09-13 DOI:10.7812/TPP/23.160
Catherine C Alexander, Hasna Hakim, Elaine Rudell, Michele Ingram, Tarjani Agrawal, Patty Peterson, Marianne Davies, Kerin Adelson, Brant J Oliver
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Abstract

Background: 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.

Methods: 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.

Results: 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%).

Conclusion: 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.

在一家主要的学术肿瘤中心培养一线共同决策 (SDM) 能力,为非小细胞肺癌患者提供护理:SDM 模拟培训项目的绩效成果。
背景:全球有关共同决策(SDM)培训项目的证据越来越多。然而,无论是学术界(即医学院)还是实践环境,在项目设计、持续时间、有效性和评估方面都存在很大差异。SDM 培训在实践环境中的整合速度一直很慢:方法:采用定量和定性方法对 6 名多学科临床医生进行了试点研究,以评估参与者对 SDM 在实践环境中的理解和实施的变化。在培训前后,作者采用了基于标准的双评定方法,使用 SDM 的 7 个领域对基于模拟的病例研究角色扮演计划进行了评估。作者评估了临床医生在模拟病例研究角色扮演中是否涉及了 7 个领域中的每个领域,或每个领域中涉及的部分内容。在干预前后进行了焦点小组讨论,以向参与者提供反馈,并更详细地了解临床医生的体验:结果:SDM 的改进幅度在 17% 至 37% 之间,在对参与者进行评分的 8 个领域中,有 7 个领域有显著改进。改善最大的领域是确定患者的目标/偏好,包括治疗的风险承受能力(+37%)以及价值观和自我效能感(+37%):本研究结果表明,临床医生对患者目标、偏好和价值观的认识发生了显著转变。干预后,临床医生开始认识到与患者建立伙伴关系的价值,即患者成为临床护理的积极参与者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
The Permanente journal
The Permanente journal Medicine-Medicine (all)
CiteScore
2.20
自引率
0.00%
发文量
86
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