Development of a communication skills based workshop for Shared Decision-Making (SDM)

Abstract

Rationale, aims and objectives:Shared Decision-Making (SDM) is increasingly recommended to improve patient-centered care. Implementation of SDM in routine practice has been challenging.  Our aim was to develop and evaluate a brief SDM workshop based on a communication skills approach for primary care physicians (PCPs). The clinical problem chosen was one in which over-treatment is a concern: screening and treatment options in stable coronary artery disease (CAD) following a mildly abnormal stress test.  Method: Essential training tasks were identified from existing communication skills and shared decision-making skills. A 90-minute workshop was developed for use with a patient decision aid. Didactic content and role plays featuring 3 case scenarios with interactive feedback formed the approach. Participants were academic internal and family medicine PCPs. Retrospective pre-post surveys evaluated self-reported effectiveness in actual clinic encounters. Results: Seventy-two percent (21/29) of PCPs in the 2 clinics participated in the Communication-Shared Decision Making (COMM-SDM) Training Program. Providers reported increased confidence in doing shared decision-making with CAD patients. Decreases in confidence occurred in the specific task of “setting the stage for the encounter”. Some PCPs were uncomfortable with counseling patients making decisions about optimal medical therapy or percutaneous coronary intervention (PCI), preferring the cardiologist to discuss the options.Conclusions: SDM as an extension of a communication approach appears logistically feasible. The essential tasks of this training approach may be applicable to other clinical decisions where shared decision-making is appropriate, either because the decisions are preference sensitive or because testing and treatment patterns are frequently inconsistent with scientific evidence.