The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark

ObjectiveAs a part of an evaluation of a large-scale communication skills training (CST) programme, this study aimed to investigate the effect on health care professionals’ (HCPs) self-efficacy (SE) and perceived importance (PI) of the skills taught.MethodsA pre-post intervention design was used, and 1647 HCPs responded to the SE-12 questionnaire. Changes in self-efficacy were examined at an item and scale level.ResultsThe responses of 74% of the HCPs who replied to at least two of the three questionnaires were analysed. A significant increase in the SE-12 scale scores by 12.45 points between Q1 (baseline) and Q2 (immediately after the intervention) across all professions was found. There was a small albeit statistically significant decrease in the SE-12 scale scores by 2.06 points between Q2 and Q3 (24 weeks after the intervention).ConclusionThe implementation of the CST course significantly improved the self-efficacy of HCPs. The findings were supported by an increase in the number of HCPs who considered the skills that they had acquired to be very important.Practice implicationsThe findings suggest that the large-scale implementation of evidence-based CST programmes can yield the same outcomes that have been observed in smaller and better controlled studies.     

Communication skills training for healthcare professionals in providing genetic counseling: A scoping literature review

ObjectiveGenetic counselors need advanced communication skills, particularly when discussing tests involving massively parallel sequencing. Increasingly, non-genetic healthcare professionals (HCPs) also need to provide genetic counseling. Communication skills training (CST) may equip HCPs with the required communication skills. This scoping review provides an overview of the content, approach, effectiveness and effective features of CSTs aimed at improving genetic and non-genetic HCPs’ communication skills in providing genetic counseling.MethodsFollowing the PRISMA-ScR statement, four databases were searched for articles. Two researchers independently screened titles and abstracts, and extracted data. When applicable, information on effectiveness and effective features of CST was collated.ResultsTwenty-three articles were included. Sixteen CSTs targeted non-genetic HCPs, five targeted genetic HCPs and two targeted both. Most CSTs addressed multiple communication behaviors and consisted of role play. CSTs were found to be effective for improving HCPs (mainly self-reported) attitudes and skills. Limited evidence on specific effective features of CST was found.ConclusionsThere is a clear need for evidence on the effectiveness of CST on improving both HCPs’ communication skills in the context of genetic counseling, and patient outcomes, and its specific effective features.Practice implicationsClinical practice could benefit from evidence-based CST for genetic and non-genetic HCPs.     

National train-the-trainer certificate programme for improving healthcare communication in Austria

ObjectivesIn Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals.MethodsThe programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated.Results18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants’ satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified.ConclusionsThis programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST.Practice implicationsImplementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.     

A randomized controlled trial assessing behavioral,cognitive, emotional and physiological changes resulting from a communication skills training in physicians caring for cancer patients

ObjectiveThis randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients.MethodsMedical specialists (N = 90) were randomly assigned in groups to complete a manualized 30-h CST or to a waiting list. Assessments included behavioral (communication skills), cognitive (self-efficacy, sense of mastery), emotional (perceived stress) and physiological (heart rate) measures. Assessments were made at baseline (both groups), after CST program (training group), and four months after (waiting list group). All assessments were conducted before, during, and after a complex communication task with an advanced-stage cancer simulated patient (SP).ResultsTrained physicians had higher levels of communication skills (from RR=1.32; p = .003 to RR=41.33; p < .001), self-efficacy (F=9.3; p = .003), sense of mastery (F=167.9; p < .001) and heart rate during the SP encounter (from F=7.4; p = .008 to F=4; p = .050) and same levels of perceived stress (F=3.1; p = .080).ConclusionA learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process.Practice implicationsTrainers should consider the CST multilevel benefits (behavioral, cognitive, emotional and physiological) before, during and after a complex communication simulated task as an innovative way to assess the efficacy of a communication skills learning process.     

Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care

ObjectiveBoth patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations.MethodsAn exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings.Results24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings.ConclusionsPersuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact.Practice implicationsAwareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information.     

Opportunities and limitations of shared decision making in multidisciplinary tumor conferences with patient participation – A qualitative interview study with providers

ObjectiveThe aim of this study was to examine opportunities and limitations of shared decision making in multidisciplinary tumor conferences with patient participation from the providers’ perspective in breast and gynecological cancer centers.MethodsSemi-structured guideline-based expert interviews were conducted with providers from breast and gynecological cancer centers with and without patient participation in multidisciplinary tumor conferences. Interviews were transcribed, anonymized and analyzed using qualitative content analysis.ResultsThe providers (n = 30) reported that some process steps of shared decision making can be implemented in limited form and under certain conditions in multidisciplinary tumor conferences with patient participation. Above all, patients can potentially ask questions and contribute individual additional information and their preferences.ConclusionThis study contributes first insights into the implementation of shared decision making in multidisciplinary tumor conferences with patient participation. From the providers’ perspective, the implementation of shared decision making seems difficult under the current circumstances. Further studies, using patient experiences, participative observations or interventional designs, are required.Practice ImplicationsDespite the limited implementation of shared decision making in tumor conferences, patient participation can be advantageous as it can allow patients to ask questions and contribute individual additional information as well as their preferences.     

Barriers and facilitators to shared decision-making in neonatal medicine: A systematic review and thematic synthesis of parental perceptions

ObjectivesSystematically review parental perceptions of shared decision-making (SDM) in neonatology, identifying barriers and facilitators to implementation.MethodsElectronic database (Medline, PsycINFO, CINAHL and Scopus) and follow-up searches were conducted to identify qualitative studies. Data were extracted, thematically analysed and synthesised.ResultsSearches yielded 2445 papers, of which 25 were included. Thematic analysis identified six key themes. Key barriers included emotional crises experienced in the NICU setting, lack of medical information provided to parents to inform decision-making, inadequate communication of information, poor relationships with caregivers, lack of continuity in care, and perceived power imbalances between HCPs and parents. Key facilitators included clear, honest and compassionate communication of medical information, caring and empathetic caregivers, continuity in care, and tailored approaches that reflected parent’s desired level of involvement.ConclusionThe highly specialised environment, and the emotional crises experienced by parents impact significantly on their perceived capacity to engage in surrogate decision-making.Practice ImplicationsComplex and multi-factorial interventions that address the training needs of HCPs, and the emotional, informational and decision support needs of parents are needed. SDM skills training, improved information delivery, and integrated emotional and decisional support could help parents to become more involved in SDM for their infant.     

iBDecide: A web-based tool to promote engagement in shared decision-making among adolescents with ulcerative colitis

BackgroundAdolescents and young adults (AYAs) seek increased autonomy and self-efficacy. AYAs must learn to manage their medical care in preparation for transition to adult healthcare. Our team’s research found that AYAs need more information about their disease and treatmentObjectiveTo develop and test the usability of a decision tool “iBDecide” to promote shared decision-making among AYAs with ulcerative colitis (UC) who are beginning to manage their treatment and medicationsMethodsUsing design thinking, 14 AYAs, 6 healthcare providers, 4 designers, a social worker, and a human factors researcher developed a shared decision-making tool. The System Usability Scale (SUS) assessed usabilityResultsAYAs preferred an application with information on treatment, medication, nutrition, and symptom tracking. A web-based application, ‘iBDecide’, was developed to include these options. SUS results indicated that participants on average “agree” that: ‘they would use iBDecide’ and that ‘it was easy to use and streamlined’. The mean SUS score was 78.25 (+/?12.91), range 70–90DiscussionIncluding AYAs in tool development helps ensure usability and improves engagement in shared decision-making. Co-designed tools may remove barriers for engagement and skill-building needed for the transition to adult care.ConclusioniBDecide can stimulate AYA engagement in shared decision-making in treating UC.     

Communicating with older adults with long-term conditions about self-management goals: A systematic review and thematic synthesis

ObjectiveTo synthesise a body of fine-grained observational research on communication between healthcare professionals (HCPs), older adults, and carers regarding self-management goals and actions.MethodsWe conducted a systematic review, searching nine electronic databases and the grey literature. Two reviewers independently selected for inclusion following a two-stage process and studies and discrepancies were resolved through consultation with the review team.Results898 records were retrieved, and eight studies were included in the review. Aggregative thematic analysis resulted in 13 categories of communication practices across three decision-making domains: (1) initiating: actions occurring prior to the commitment point; (2) proposing: putting forward a course of action; and (3) committing and closing: committing (or not) to the course of action.ConclusionsDespite an increasing emphasis on the importance of personalised care planning and shared decision-making (SDM) to support older people’s health and wellbeing, HCPs did not consistently practice this approach and, in some cases, worked in opposition to it.Practice implicationsWe encourage HCPs to prepare older adults to engage actively with SDM and the goal setting process by employing patient-centred communication resources. These could assist with identifying different types of goals that are realistic and relevant to patients in daily life.     

Development of a scale to measure shared problem-solving and decision-making in mental healthcare

ObjectivesThe aim of this study was to create a measure of collaborative processes between healthcare team members, patients, and carers. Methods: A shared decision-making scale was developed using a qualitative research derived model and refined using Rasch and factor analysis. The scale was used by staff in the hospital for four consecutive years (n = 152, 121, 119 and 121) and by two independent patients’ and carers’ samples (n = 223 and 236). Results: Respondents had difficulty determining what constituted a decision and the scale was redeveloped after first use in patients and carers. The initial focus on shared decision-making was changed to shared problem-solving. Two factors were found in the first staff sample: shared problem-solving and shared decision-making. The structure was confirmed on the second patients’ and carers’ sample and an independent staff sample consisting of the first data-points for the last three years. The shared problem-solving and decision-making scale (SPSDM) demonstrated evidence of convergent and divergent validity, internal consistency, measurement invariance on longitudinal data and sensitivity to change. Conclusions: Shared problem-solving was easier to measure than shared decision-making in this context. Practice implications: Shared problem-solving is an important component of collaboration, as well as shared decision-making.     

Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: A randomized controlled trial

ObjectiveTo evaluate the efficacy of shared decision-making (SDM) intervention among patients with lumbar degenerative diseases (LDDs) in terms of decision self-efficacy, control preferences, SDM process, decision satisfaction, and conflict.MethodsA total of 130 outpatients with LDDs recruited from orthopedic or rehabilitation clinics were randomly assigned to the SDM intervention (n = 67) or comparison (n = 63) groups. Patients in the intervention group received decision aids (DAs) with decision coaching and those in controlled group received standard educational materials from a health educator. The primary outcome was decision self-efficacy, and secondary outcomes were control preference, SDM process, conflict, and satisfaction.ResultsThe SDM intervention significantly improved decision self-efficacy (mean difference [MD] = 7.1, 95% confidence interval [CI]: 1.7–12.5, partial η² = 0.05) and reduced conflict (MD = −7.0, 95% CI: −12.2 to −1.9, partial η² = 0.06), especially in patients without family involvement, compared with the health education group. However, no significant between-group differences were observed in other outcomes.ConclusionSDM intervention improved SDM self-efficacy and reduced conflict in patients with LDDs.Practice ImplicationsClinicians can integrate DAs and decision coaching in SDM conversations. SDM intervention seems to engage patients in decision-making, especially those without family involvement.     

Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review

ObjectiveEnd-of-life communication has been largely recognized to promote quality end-of-life care in nursing home (NHs) by increasing residents’ likelihood of receiving comfort-oriented care. This scoping review summarizes what is known about the potential mechanisms by which end-of-life communication may contribute to palliative-oriented care in NHs.MethodsUsing the framework proposed by Arksey and O’Malley and refined by the Joanna Briggs Institute methodology, five literature databases were searched. We extracted 2159 articles, 11 of which met the inclusion criteria: seven quantitative, three qualitative, and one mixed-methods study.ResultsThree mechanisms were identified: a) promotion of family carers’ understanding about their family member’s health condition, prognosis, and treatments available; b) fostering of shared decision-making between health care professionals (HCPs) and residents/family carers; and c) using and improving knowledge about residents’ preferences.ConclusionFamily carers’ understanding, shared decision-making, and knowledge of residents’ preferences contribute to palliative-oriented care in NHs.Practice implicationsDiscussions about end-of-life should take place early in a resident’s disease trajectory to allow time for family carers to understand the condition and participate in subsequent, mindful, shared decision-making. HCPs should conduct systematic and thorough discussions about end-of-life treatment options with all cognitively competent residents to promote informed advance directives.     

Communicating shared decision-making: Cancer patient perspectives

Objective

To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients’ perspectives.

Methods

Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients.

Results

Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care.

Conclusion

In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities.

Practice implications

Shared decision-making as a practice standard must be balanced against individual patient preferences.     

Impact of specialized pediatric palliative care programs on communication and decision-making

ObjectiveTo summarize and analyze the impact of specialized pediatric palliative care (SPPC) programs on communication and decision-making for children with life-threatening conditions.MethodsOur search strategy covered MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase through September 2018.ResultsWe reviewed 13 studies analyzing the impact of SPPC programs on communication and decision-making using a wide range of outcome indicators. Study quality was poor in 58% of included papers. SPPC programs improved communication and decision-making between families and healthcare professionals (HCPs), within and between families, and among HCPs.ConclusionSPPC programs generally support and improve communication and decision-making for children with life-threatening conditions, their families and associated HCPs. Families referred to an SPPC program had more discussions with HCPs on a broad variety of topics. However, data on communication with children, siblings, and other family members was scarce and of poor quality.Practice implicationsMore research on SPPC program efficacy is needed from the perspective of the ill child, as well as about barriers to end-of-life discussions and the specific aspects of SPPC programs responsible for improving outcomes.     

Building ground for didactics in a patient decision aid for hip osteoarthritis. Exploring patient-related barriers and facilitators towards shared decision-making

ObjectiveThe aim of the present study was to explore patient-related barriers and facilitators towards shared decision-making (SDM) during routine orthopedic outpatient consultations as part of the process of developing a patient decision aid (PDA) for patients with hip osteoarthritis (OA).MethodsConsultations comprising nineteen hip OA patients referred to an orthopedic surgeon for treatment decision-making were observed, audio recorded and transcribed. Iterative thematic analysis proceeded, based on a taxonomy of generic patient-related barriers towards SDM grounded in the Theory of Planned Behavior (TPB).ResultsA targeted taxonomy provided a structured overview of 26 factors influencing hip OA patients’ intention to engage in SDM. Patients’ perceived ability to change the agenda of the visit emerged as seminal factor and was added to the generic taxonomy.ConclusionUsing a TPB-based taxonomy, we were able to identify and structure generic and context specific SDM barriers. Addressing patients’ communication self-efficacy should be included as didactic feature in PDAs.Practice implicationsPDAs for hip OA should be designed for the broad spectrum of decision-making support needs occurring throughout the continuum of the disease. The provided taxonomy may contribute as guidance within implementation strategies that aim to support patients’ intentions to engage in SDM.     

Assessment of medical students’ shared decision-making skills in simulated physician-patient encounters

ObjectiveTo compare shared decision-making skills of medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task.Methods29 medical students who voluntarily translated medical documents for patients into plain language on the online-platform https://washabich.de (WHI group) and 29 medical students who did not (non-WHI group) participated in a simulated virtual consultation hour. Via skype, participants communicated with six simulated patients. All conversations were transcribed and a blinded rater assessed them with the OPTION scale for shared decision-making.ResultsThe WHI group received significantly (p < .001) higher total scores for shared decision-making with the OPTION scale than the non-WHI group. The greatest differences in scores were found for the items “The clinician checks that the patient has understood the information.” (WHI: 2.98 ± 0.77 vs. non-WHI: 2.61 ± 0.89, p < .001) and “The clinician offers the patient explicit opportunities to ask questions during the decision-making process.” (WHI: 2.83 ± 1.00 vs. non-WHI: 2.40 ± 1.07, p < .001).ConclusionWritten translation of medical documents is associated with significantly better OPTION scores for shared decision-making in simulated physician-patient encounters.Practice ImplicationsTo use written medial translation exercises in general to improve medical students’ shared decision-making skills.     

Factors influencing patient education in shared medical appointments: Integrative literature review

ObjectiveThis integrative literature review investigates the factors influencing patient education in Shared Medical Appointments.MethodsFollowing template analysis method, we used key concepts of the Social Cognitive Theory (SCT) and Social Constructivism as a priori themes. After detailed analysis of the included studies, we deduced subthemes, forming a final template. Based on this final template, we analysed our data again as a final check.ResultsWe included 22 studies. We found that the factors feeling of bonding, humour, feeling of safety, access to information, time, relationship participants-staff, modelling and self-regulation influence the education of SMA participants. Furthermore, we found that health care providers function both as leaders and peers.ConclusionWe found eight factors that influence the education of SMA participants. Health care providers exert influence on these factors, but in turn, they are also influenced by them in their transfer of knowledge.Practice implicationsIn order to create a climate of learning and to promote transfer of knowledge, these eight factors should be considered. Health care providers should be aware of their roles and they might need some extra skills for their leadership roles. This can also lead to practical implications for the curriculum in medical schools.     

Association of conflicting information from healthcare providers and poor shared decision making with suboptimal adherence in direct oral anticoagulant treatment: A cross-sectional study in patients with atrial fibrillation

ObjectiveTo assess direct oral anticoagulant (DOAC) adherence and to determine possible determinants for suboptimal adherence in Dutch patients with atrial fibrillation (AF).MethodsCross-sectional study of DOAC users who completed a self-reported questionnaire. Adherence was measured with Morisky8-item Medication Adherence Scale (MMAS-8). Logistic regression analysis was conducted to investigate determinants affecting adherence.Results398 DOAC users completed the questionnaire (mean age 70.6 ± 9.2years). Approximately one in four patients had suboptimal adherence (MMAS-8 < 8). Multivariable analysis showed that patients who felt to have received conflicting information about the treatment, patients with higher educational level and patients who were not sufficiently involved in the treatment choice had a higher odds of suboptimal adherence.ConclusionDOAC adherence was suboptimal. Conflicting information received from different healthcare providers (HCPs), lack of shared decision making and the patients’ educational level were determinants negatively affecting DOAC adherence.Practice implicationsEfforts towards identifying suboptimally adherent DOAC patients are needed since they are at higher risk to develop thromboembolic events. Adherence counselling should be systematically and repeatedly encouraged and shared decision making should become more mainstream. Moreover, reinforced education of both patients and HCPs combined with interprofessional collaboration are potential solutions to prevent knowledge gaps and communication of conflicting information.     

Effectiveness of interprofessional shared decision-making training: A mixed-method study

ObjectiveThis study evaluated the learning effects and examined the participants’ perceptions of an interprofessional shared decision-making (IP-SDM) training program.MethodsThis mixed-method study used a quasi-experimental pretest–posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb’s experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules.ResultsA total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners’ attitude, knowledge, skills, and teamwork.ConclusionThis IP-SDM training program improved multidisciplinary healthcare personnel’s competency, self-efficacy, and intention to engage in IP-SDM.Practice implicationsApplying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel’s knowledge, attitude, skills, and teamwork in IP-SDM.