Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Oncologist. 2019 Feb;24(2):259-265. doi: 10.1634/theoncologist.2018-0090. Epub 2018 Jun 29.
Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. This study examines the effect of shared decision-making (SDM) training for medical oncologists on observed SDM in standardized patient assessments.
A randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists-in-training ( = 31) participated in a video-recorded, standardized patient assessment at baseline (T0) and after 4 months (T1, after training). The training was based on a four-stage SDM model and consisted of a reader, two group sessions (3.5 hours each), a booster session (1.5 hours), and a consultation card. The primary outcome was observed SDM as assessed with the Observing Patient Involvement scale (OPTION12) coded by observers blinded for arm. Secondary outcomes were observed SDM per stage, communication skills, and oncologists' satisfaction with communication.
The training had a significant and large effect on observed SDM in the simulated consultations (Cohen's f = 0.62) and improved observed SDM behavior in all four SDM stages (f = 0.39-0.72). The training improved oncologists' information provision skills (f = 0.77), skills related to anticipating/responding to emotions (f = 0.42), and their satisfaction with the consultation (f = 0.53).
Training medical oncologists in SDM about palliative systemic treatment improves their performance in simulated consultations. The next step is to examine the effect of such training on SDM in clinical practice and on patient outcomes.
Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. Hence, applying the premises of shared decision-making (SDM) is recommended. SDM is increasingly advocated based on the ethical imperative to provide patient-centered care and the increasing evidence for beneficial patient outcomes. Few studies examined the effectiveness of SDM training in robust designs. This randomized controlled trial demonstrated that SDM training (10 hours) improves oncologists' performance in consultations with standardized patients. The next step is to examine the effect of training on oncologists' performance and patient outcomes in clinical practice.
晚期癌症的系统治疗提供的益处不确定，有时有限，而负担可能很高。本研究考察了对医学肿瘤学家进行共享决策（SDM）培训对标准化患者评估中观察到的 SDM 的影响。
进行了一项比较培训与标准实践的随机对照试验。医学肿瘤学家和肿瘤学实习生（n=31）在基线（T0）和 4 个月后（T1，培训后）参加了视频记录的标准化患者评估。培训基于四阶段 SDM 模型，包括阅读者、两个小组会议（每次 3.5 小时）、强化会议（1.5 小时）和咨询卡。主要结局是使用观察患者参与量表（OPTION12）评估的观察到的 SDM，观察者对臂进行盲法编码。次要结局是每个阶段的观察到的 SDM、沟通技巧和肿瘤学家对沟通的满意度。
培训对模拟咨询中的观察到的 SDM 有显著和较大的影响（Cohen's f=0.62），并改善了所有四个 SDM 阶段的观察到的 SDM 行为（f=0.39-0.72）。培训提高了肿瘤学家的信息提供技能（f=0.77）、与预期/回应情绪相关的技能（f=0.42）和他们对咨询的满意度（f=0.53）。
对姑息性系统治疗的晚期癌症进行 SDM 培训可提高模拟咨询中肿瘤学家的表现。下一步是研究这种培训对临床实践中的 SDM 和患者结局的影响。
晚期癌症的系统治疗提供的益处不确定，有时有限，而负担可能很高。因此，建议应用共享决策（SDM）的前提。基于提供以患者为中心的护理的伦理必要性和对有益的患者结局的越来越多的证据，SDM 越来越受到提倡。很少有研究在稳健设计中检验 SDM 培训的有效性。这项随机对照试验表明，SDM 培训（10 小时）可提高肿瘤学家在与标准化患者的咨询中的表现。下一步是研究培训对肿瘤学家在临床实践中的表现和患者结局的影响。
