A randomised trial of training student clinicians in how to facilitate shared decision making and communicate evidence: the ignored step in evidence-based practice?

Article type
Authors
Hoffmann T1, Del Mar C1, Bennett S2, Claire T2
1Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Australia
2School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Abstract
Background: Successful evidence-based practice requires clinicians to practice patient-centred care. Central to this is shared decision making (SDM); of which, a key skill is communicating statistical information clearly to patients. Most clinicians do this poorly, if at all. One reason is lack of training: evidence-based practice courses and workshops typically do not include these skills. Teaching these skills to student clinicians during evidence-based practice training may be valuable, but methods for doing this have not been evaluated.

Objectives: To evaluate, in a multi-site randomised trial, the effectiveness of a brief intervention designed to increase student clinicians’ ability tofacilitate SDM and evidence communication skills.

Methods: Medical, physiotherapy and occupational therapy undergraduate, honours, and postgraduate students (n = 107) were randomly allocated to an intervention or control group. Intervention group participants received brief training in SDM and evidence communication skills. At baseline and post-intervention, participants performed role-plays which were videorecorded and evaluated by a blinder assessor using the Observing Patient Involvement (OPTION) scale (range 1–100) and selected Assessing Communication about Evidence and Preferences (ACEP) Coding Scheme items (range 0–5) to assess shared decision-making and evidence communication skill as the primary outcome measures. Secondary outcome measures were confidence in and attitudes towards SDM.

Results: Post-intervention, intervention group participants scored significantly higher on the OPTION scale (mean between-group difference = 19.2, 95% CI 12.3–26.0), ACEP items (difference = 1.0, 95% CI 0.5–1.4), confidence measure (difference = 13.3, 95% CI 7.3–19.4), and Sharing subscale of the attitude measure (difference = 0.5, 95% CI 0.2–0.7). The between-group difference for the Caring subscale of the attitude measure was not significant.

Conclusions: The intervention was effective in improving student clinicians’ ability, attitude, and confidence in facilitating SDM and communicating evidence. Further evaluation of this intervention is warranted.