Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations.

OBJECTIVES: Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. DESIGN: Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. SETTING: We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5. PARTICIPANTS: Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. RESULTS: We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients. CONCLUSIONS: The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.

Integrating medical and practical skills in communication skills training: Do students feel it supports them with transfer from classroom to practice?

Objective: To describe innovations in a clinical communication skills training (CCST) program, aimed at facilitating transfer of communication skills from classroom to clinical practice and report student's evaluations regarding this program. Methods: To facilitate transfer, we integrated CCS with medical and practical skills, and we developed simulation sessions closely resembling clinical practice in case-history's, length of consultation, and patient-population. Feedback was given on communication skills and medical knowledge and skills. Student's opinions about whether these elements were helpful, were evaluated using a questionnaire. Results: Responses of 144 students were analyzed. The majority of the respondents agreed that this CCST program helped them with transfer of CCS from classroom to clinical practice, as did the feedback on medical content and communication skills in the same session. Conclusion: Students indicate that simulations resembling clinical practice and feedback on both CST and medical content facilitate the transfer of their skills to clinical practice. Innovation: This CCST program is innovative because it integrates medical and practical skills, with elements aiming to create an educational environment resembling clinical practice as closely as possible in order to facilitate transfer to clinical practice.