Depression, Low Back Pain
Conditions
Keywords
Communication skills training, Shared Decision Making, Decision making, Decision Aids, lung cancer screening
Brief summary
The Health Decision Sciences Center (HDSC) staff has deployed different approaches to training clinicians to engage patients in shared decision making for common medical tests and treatments. The purpose of the study is to compare the effectiveness of shared decision making (SDM) skills training courses using standardized patient interactions (SPI) and written evaluations.
Detailed description
There is limited evidence on approaches to training clinicians to engage patients in shared decision making for common medical tests and treatments. The purpose of the study is to compare the effectiveness of different approaches to shared decision making (SDM) skills training. Participants will be randomly assigned to either receive two decision aids or a webinar to review. Participants will also be randomly assigned to receive feedback on standardized patient interaction rating their shared decision making skills and highlighting opportunities for improvement or not. Clinician participants will be assigned to one of four intervention groups using a 2x2 factorial design: Group 1: Decision aid viewing with feedback Group 2: Decision aid viewing and no feedback Group 3: webinar with feedback Group 4: webinar and no feedback The pilot study will provide evidence on the comparative effectiveness and feasibility on training formats to determine if: * Clinicians improved in SDM communication skills * Clinicians have an increased confidence to use SDM with their patients * The training is acceptable to clinicians
Interventions
BEHAVIORALWebinar
1 hour online, interactive webinar that covers shared decision making skills in clinical encounters.
BEHAVIORALDA viewing
Participants will receive 3 decisions aids to review.
BEHAVIORALSPI feedback
Rating of shared decision making skills and opportunities for improvement based on transcript of a standardized patient interaction
Sponsors
Partners HealthCare
Massachusetts General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults 18 and older * English speaking * Physician * Nurse Practitioner * Physician Assistant * Registered Nurse
Exclusion criteria
* Not clinically active (research faculty only) * Medical Trainees * Medical Students * Medical Assistants * Social Workers
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Braddock's Informed Decision Making Score | Baseline (before intervention) and 4-6 weeks (after intervention) | Transcripts from standardized patient interactions (SPI) will be scored using Braddock's Informed Decision Making (IDM) framework to assess shared decision making skills. Scores with the Braddock's Informed Decision Making Framework range from 0 to 9; the higher scores are better. We subtracted the scores of the baseline SPI collected before the intervention from the second SPI collected 4-6 weeks later, after the intervention, to determine the change in IDM score for each participant and then compared change scores across study arms. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| DA Viewing With SPI Feedback Group 1 receives three decision aids and feedback on their standardized patient (SPI) interaction rating their shared decision making skills and highlighting opportunities for improvement.
DA viewing: Participants will receive 3 decisions aids to review.
SPI feedback: Rating of shared decision making skills and opportunities for improvement based on transcript of a standardized patient interaction | 6 |
| DA Viewing With no SPI Feedback Group 2 receives three decision aids. This group does not receive any feedback from the SPI.
DA viewing: Participants will receive 3 decisions aids to review. | 6 |
| Webinar With SPI Feedback Group 3 receives an online, interactive webinar that focuses on SDM skills in clinical encounters and feedback on their standardized patient (SPI) interaction rating their shared decision making skills and highlighting opportunities for improvement.
Webinar: 1 hour online, interactive webinar that covers shared decision making skills in clinical encounters.
SPI feedback: Rating of shared decision making skills and opportunities for improvement based on transcript of a standardized patient interaction | 4 |
| Webinar With no SPI Feedback Group 4 receives an online, interactive webinar that focuses on SDM skills in clinical encounters. This group does not receive any feedback from the SPI.
Webinar: 1 hour online, interactive webinar that covers shared decision making skills in clinical encounters. | 7 |
| Total | 23 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 3 | 2 | 0 | 2 |
Baseline characteristics
| Characteristic | Webinar With SPI Feedback | Webinar With no SPI Feedback | Total | DA Viewing With SPI Feedback | DA Viewing With no SPI Feedback |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 4 Participants | 7 Participants | 22 Participants | 5 Participants | 6 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants | — | — |
| Region of Enrollment United States | 4 participants | 7 participants | 23 participants | 6 participants | 6 participants |
| Sex: Female, Male Female | 4 Participants | 6 Participants | 17 Participants | 5 Participants | 2 Participants |
| Sex: Female, Male Male | 0 Participants | 1 Participants | 6 Participants | 1 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Change in Braddock's Informed Decision Making Score
Transcripts from standardized patient interactions (SPI) will be scored using Braddock's Informed Decision Making (IDM) framework to assess shared decision making skills. Scores with the Braddock's Informed Decision Making Framework range from 0 to 9; the higher scores are better. We subtracted the scores of the baseline SPI collected before the intervention from the second SPI collected 4-6 weeks later, after the intervention, to determine the change in IDM score for each participant and then compared change scores across study arms.
Time frame: Baseline (before intervention) and 4-6 weeks (after intervention)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| DA Viewing With SPI Feedback | Change in Braddock's Informed Decision Making Score | 2.00 score on a scale | Standard Deviation 1.29 |
| DA Viewing With no SPI Feedback | Change in Braddock's Informed Decision Making Score | 1.25 score on a scale | Standard Deviation 2.06 |
| Webinar With SPI Feedback | Change in Braddock's Informed Decision Making Score | 1.00 score on a scale | Standard Deviation 0.82 |
| Webinar With no SPI Feedback | Change in Braddock's Informed Decision Making Score | 3.20 score on a scale | Standard Deviation 1.79 |