Physicians' and residents' educational needs regarding shared decision making: A focus group study.

OBJECTIVES: To explore the educational needs of physicians and residents regarding shared decision making (SDM). METHODS: We conducted eight focus groups with 12 general practitioners (GPs), 14 hospital specialists, 12 hospital specialist residents and 13 GP residents in Belgium. We used thematic analysis to guide data analysis. RESULTS: We identified five educational needs: (1) the need for a clear understanding of the definition of SDM and its scope; (2) how to deal with a changing professional identity; (3) acquisition of skills to perform SDM; (4) the need for reflective practice in a supportive environment; and (5) sustainable and longitudinal integration in education. CONCLUSIONS: This is the first focus group study emphasizing dealing with a changing professional identity as an educational need, besides the need for SDM-related knowledge and skills. Physicians stated that implementing spiral learning is needed at all stages of medical training, aimed at all specialties to foster interprofessional collaboration. PRACTICE IMPLICATIONS: Our findings can support development of future educational SDM interventions, integrating both competence development and professional identity formation. We provide practical recommendations on didactic formats and strategies, hoping to finally reach better implementation of SDM in daily practice.

A systematic review of shared decision making training programs for general practitioners.

BACKGROUND: Shared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority feature of high-quality patient-centered care. Considering the foundation of trust between general practitioners (GPs) and patients and the variety of diseases in primary care, the primary care context can be viewed as roots of SDM. GPs are requesting training programs to improve their SDM skills leading to a more patient-centered care approach. Because of the high number of training programs available, it is important to overview these training interventions specifically for primary care and to explore how these training programs are evaluated. METHODS: This review was reported in accordance with the PRISMA guideline. Eight different databases were used in December 2022 and updated in September 2023. Risk of bias was assessed using ICROMS. Training effectiveness was analyzed using the Kirkpatrick evaluation model and categorized according to training format (online, live or blended learning). RESULTS: We identified 29 different SDM training programs for GPs. SDM training has a moderate impact on patient (SMD 0.53 95% CI 0.15-0.90) and observer reported SDM skills (SMD 0.59 95%CI 0.21-0.97). For blended training programs, we found a high impact for quality of life (SMD 1.20 95% CI -0.38-2.78) and patient reported SDM skills (SMD 2.89 95%CI -0.55-6.32). CONCLUSION: SDM training improves patient and observer reported SDM skills in GPs. Blended learning as learning format for SDM appears to show better effects on learning outcomes than online or live learning formats. This suggests that teaching facilities designing SDM training may want to prioritize blended learning formats. More homogeneity in SDM measurement scales and evaluation approaches and direct comparisons of different types of educational formats are needed to develop the most appropriate and effective SDM training format. TRIAL REGISTRATION: PROSPERO: A systematic review of shared-decision making training programs in a primary care setting. PROSPERO 2023 CRD42023393385 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393385 .