Scherer Laura D, Matlock Daniel, Knoepke Christopher, Wearner Robyn, Gottsman Allyson, Fernald Douglas, Dickinson W Perry, Dickinson L Miriam, McNulty Monica, Gritz Mark
University of Colorado School of Medicine, 1890 N Revere Ct, Third Floor, Mail Stop F443, Aurora, CO, 80045, USA.
VA Eastern Colorado, 1700 North Wheeling Street, Aurora, CO, 80045-7211, USA.
J Gen Intern Med. 2025 Sep 10. doi: 10.1007/s11606-025-09465-y.
The SHARE Approach Model and training curriculum was developed by the Agency for Healthcare Research and Quality (AHRQ) to teach clinicians practicing in diverse settings how to engage in more effective Shared Decision Making (SDM).
To determine the effectiveness of the SHARE Approach at improving SDM in practices located across Colorado, USA.
A longitudinal study with pre- and post-intervention observations.
Primary care and cardiology practices were recruited from across Colorado. All practice staff were invited to participate in the SHARE Approach training. Patients and providers from these practices participated in SDM assessments.
The 4-h SHARE Approach training was led by a practice facilitator and consisted of didactic lectures, demonstration videos, group discussion, and group activities.
Primary outcome measures included (1) evaluation of the training and confidence/understanding in doing SDM using a survey questionnaire of practice staff, (2) patient and clinician-reported SDM occurring in clinical encounters, and (3) SDM captured in audio recordings of a subset of clinical encounters. SDM was hypothesized to improve at post-intervention and maintain gains at follow-up.
Ten primary care and two cardiology practices enrolled in the study, located across major regions of Colorado (e.g., Western slope; Eastern plains; front range) and representing diverse practice types (e.g., independent; health system; federally qualified health center). Trainee confidence and understanding of SDM and confidence in ability to engage in SDM improved at post-test and maintained gains at follow-up. Patient- and clinician-reported SDM occurring in clinical encounters did not improve significantly at post-intervention or follow-up. SDM observed on audio recordings did improve at the 6-month follow-up observation.
This study reports the largest and most comprehensive evaluation of AHRQ's SHARE Approach training curriculum. The training was positively received by clinicians and may improve SDM behaviors in clinical practice.
医疗保健研究与质量局（AHRQ）开发了“共享方法模型”和培训课程，以教导在不同环境中执业的临床医生如何进行更有效的共同决策（SDM）。
确定“共享方法”在美国科罗拉多州各地的医疗机构中改善共同决策的有效性。
一项进行干预前和干预后观察的纵向研究。
从科罗拉多州各地招募了初级保健和心脏病学医疗机构。邀请所有医疗机构的工作人员参加“共享方法”培训。这些医疗机构的患者和提供者参与了共同决策评估。
由一名机构协调员主持为期4小时的“共享方法”培训，包括讲授式讲座、示范视频、小组讨论和小组活动。
主要结局指标包括：（1）使用医疗机构工作人员调查问卷评估培训情况以及对进行共同决策的信心/理解程度；（2）患者和临床医生报告的临床诊疗过程中发生的共同决策情况；（3）一部分临床诊疗过程录音中记录的共同决策情况。假设干预后共同决策情况会有所改善，并在随访时保持改善效果。
10家初级保健机构和2家心脏病学医疗机构参与了该研究，分布在科罗拉多州的主要地区（如西坡；东平原；前缘地区），代表了不同类型的医疗机构（如独立机构；卫生系统；联邦合格健康中心）。培训学员对共同决策的信心和理解以及参与共同决策的能力在测试后有所提高，并在随访时保持了改善效果。患者和临床医生报告的临床诊疗过程中发生的共同决策情况在干预后或随访时没有显著改善。在6个月的随访观察中，录音中观察到的共同决策情况确实有所改善。
本研究报告了对医疗保健研究与质量局“共享方法”培训课程规模最大、最全面的评估。该培训受到临床医生的积极认可，并可能改善临床实践中的共同决策行为。
