Training for Medical Oncologists on Shared Decision-Making About Palliative Chemotherapy: A Randomized Controlled Trial

The oncologist

article

Inge Henselmans¹  Geert-Jan Creemers⁴  Dirkje W. Sommeijer⁵  Filip Y.F.L. de Vos⁷  Ellen M.A. Smets¹  Hanneke W.M. van Laarhoven⁵  Hanneke C.J.M. de Haes¹  Meltem Tokat¹  Ellen G. Engelhardt²  Pomme E.A. van Maarschalkerweerd¹  Marleen Kunneman¹  Petronella B. Ottevanger^1,10  Serge E. Dohmen^1,11 

[1] Department of Medical Psychology, Academic Medical Center, University of Amsterdam;Amsterdam Public Health Research Institute;Cancer Center Amsterdam;Department of Medical Oncology, Catharina Cancer Institute;Department of Medical Oncology, Academic Medical Center, University of Amsterdam;Department of Internal Medicine, Flevo Hospital;Department of Medical Oncology, University Medical Center Utrecht, Utrecht University;Department of Epidemiology and Biostatistics, VU Medical Center;Knowledge and Evaluation Research Unit, Mayo Clinic;Department of Medical Oncology, Radboud University Medical Center;Department of Internal Medicine, BovenIJ Hospital

关键词: Shared decision-making;    Physician-patient relations;    Communication;    Medical oncology;    Palliative care;   

DOI  :  10.1634/theoncologist.2018-0090

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background 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. Materials and Methods A randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists-in-training ( n  = 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. Results 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). Conclusion 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. Implications for Practice 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.

【 授权许可】

CC BY|CC BY-NC