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Journal of Cancer Education

, Volume 27, Issue 3, pp 456–462 | Cite as

Feasibility of Training Oncology Residents in Shared Decision Making: A Pilot Study

  • Dawn StaceyEmail author
  • Rajiv Samant
  • Mistrel Pratt
  • France Légaré
Article

Abstract

Although shared decision making (SDM) is the crux of patient-centered care, physicians are not formally trained in SDM. We conducted a pre-/post-test study with oncology residents to evaluate the feasibility and acceptability of a SDM training intervention. Of 20 medical residents approached, 11 participated and rated the SDM workshop favorably. Quality of SDM provided to simulated patients were median 3.5 out of 10 (range, 1–6) at baseline, eight (4–10) within 1 month, and four (2–10) within 3 months of the workshop with higher scores reflecting more elements of SDM demonstrated. Three months after the workshop, participants reported increased sense of control over providing SDM and higher perceived expectations from others to do so. It was feasible to provide SDM training and findings suggest it increased their SDM skills. Changes in behavioral intentions appear to be influenced through the pathways of perceived behavioral control and social norms.

Keywords

Shared decision making Patient-centered care Medical residents Oncology Training Education 

Notes

Acknowledgments

Funding was received from the Educational Initiatives in Residence Education Fund in the Faculty of Medicine, University of Ottawa (June 2007 to May 2008). Dr. F. Legare holds a Canada Research Chair in Implementation of Shared Decision Making in Primary Care. We would like to thank Sara Khangura for her involvement in analyzing the taped encounters with the simulated patients and the oncology residents who gave of their time to take part in the study.

References

  1. 1.
    Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy of Sciences, New YorkGoogle Scholar
  2. 2.
    Weston WW (2009) Informed and shared decision-making: the crux of patient-centered care. Can Med Assoc J 165(4):438–439Google Scholar
  3. 3.
    Kiesler DJ, Auerbach SM (2006) Optimal matches of patient preferences for information, decision-making and interpersonal behaviour: evidence, models and interventions. Patient Educ Couns 61:319–341PubMedCrossRefGoogle Scholar
  4. 4.
    Elwyn G, Hutchings H, Edwards A, Rapport F, Wensing M, Cheung WY et al (2005) The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expect 8(1):34–42PubMedCrossRefGoogle Scholar
  5. 5.
    Loh A, Simon D, Hennig K, Hennig B, Harter M, Elwyn G (2006) The assessment of depressive patients’ involvement in decision making in audio-taped primary care consultations. Patient Educ Couns 63(3):314–318PubMedCrossRefGoogle Scholar
  6. 6.
    Stevenson FA, Cox K, Britten N, Dundar Y (2004) A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect 7(3):235–245PubMedCrossRefGoogle Scholar
  7. 7.
    Guimond P, Bunn H, O’Connor AM, Jacobsen MJ, Tait VK, Drake ER et al (2003) Validation of a tool to assess health practitioners’ decision support and communication skills. Patient Educ Couns 50(3):235–245PubMedCrossRefGoogle Scholar
  8. 8.
    Gattellari M, Ward JE (2005) Men’s reactions to disclosed and undisclosed opportunistic PSA screening for prostate cancer. Med J Aust 182(8):386–389PubMedGoogle Scholar
  9. 9.
    O’Connor AM, Sun Q, Dodin S, Feldman-Stewart D, Man-Son-Hing M, Laupacis A et al (2005) Predicting downstream effects of high decisional conflict. 3rd International Shared Decision Making Conference, OttawaGoogle Scholar
  10. 10.
    Makoul G, Clayman ML (2006) An integrative model of shared decision making in medical encounters. Patient Educ Couns 60(3):301–312PubMedCrossRefGoogle Scholar
  11. 11.
    Legare F, Stacey D, Pouliot S, Gauvin FP, Desroches S, Kryworuchko J et al (2011) Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model. J Interprof Care 25(1):18–25PubMedCrossRefGoogle Scholar
  12. 12.
    Wennberg JE (2002) Unwarranted variations in healthcare delivery: implications for academic medical centres. Br Med J 325:961–964CrossRefGoogle Scholar
  13. 13.
    Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M et al (2011) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 10:1–208Google Scholar
  14. 14.
    Towle A, Godolphin W (2001) Education and training of health care professionals. In: Edwards A, Elwyn G (eds) Evidence-based patient choice. Inevitable or impossible? Oxford University Press, Oxford, pp 245–269Google Scholar
  15. 15.
    Towle A, Godolphin W (1999) Framework for teaching and learning informed shared decision making. Br Med J 319:766–771CrossRefGoogle Scholar
  16. 16.
    Legare F, Ratte S, Gravel K, Graham ID (2008) Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns 73(3):526–535PubMedCrossRefGoogle Scholar
  17. 17.
    Pellerin MA, Elwyn G, Rousseau M, Stacey D, Robitaille H, Legare F (2011) Toward shared decision-making: using the OPTION scale to analyze resident-patient consultations in family medicine. Acad Med 86(8):1010–1018PubMedCrossRefGoogle Scholar
  18. 18.
    Legare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, Graham ID et al (2010) Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 5:1–46Google Scholar
  19. 19.
    Legare F, Turcotte S, Stacey D, Ratte S, Kryworuchko J, Graham ID (2012) Patients’ perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice. Patient 5(1):1–19PubMedCrossRefGoogle Scholar
  20. 20.
    Legare F, Politi M, Drolet R, Desroches S, Stacey D, Bekker H, et al (2012) Training health professionals in shared decision making: An international environmental scan. Patient Educ Couns. doi: 10.1016/j.pec.2012.01.002
  21. 21.
    Stacey D, O’Connor AM, Graham ID, Pomey MP (2006) Randomized controlled trial of the effectiveness of an intervention to implement evidence-based patient decision support in a nursing call centre. J Telemed Telecare 12:410–415PubMedCrossRefGoogle Scholar
  22. 22.
    Stacey D, Taljaard M, Drake ER, O’Connor AM (2008) Audit and feedback using the brief Decision Support Analysis Tool (DSAT-10) to evaluate nurse-standardized patient encounters. Patient Educ Couns 73:519–525PubMedCrossRefGoogle Scholar
  23. 23.
    Butow P, Juraskova I, Chang S, Lopez AL, Brown R, Bernhard J (2010) Shared decision making coding systems: how do they compare in the oncology context? Patient Educ Couns 78(2):261–268PubMedCrossRefGoogle Scholar
  24. 24.
    Legare F (2005) Implementation of the Ottawa Decision Support Framework in five family practice teaching units: an exploratory trial. University of Ottawa, OttawaGoogle Scholar
  25. 25.
    Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50:179–211CrossRefGoogle Scholar
  26. 26.
    Department of Family Medicine (2004) Residency booklet. University of Ottawa, OttawaGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Dawn Stacey
    • 1
    • 2
    Email author
  • Rajiv Samant
    • 3
    • 4
  • Mistrel Pratt
    • 2
  • France Légaré
    • 5
  1. 1.School of NursingUniversity of OttawaOttawaCanada
  2. 2.The Ottawa Hospital Research InstituteOttawaCanada
  3. 3.The Ottawa HospitalOttawaCanada
  4. 4.Faculty of MedicineUniversity of OttawaOttawaCanada
  5. 5.Department of Family MedicineLaval UniversityQuebec CityCanada

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