JMIR Publications

ABSTRACT

Background:

Shared decision-making leads to better healthcare processes through collaboration between healthcare professionals and patients. Among interventions developed to foster shared decision-making by healthcare professionals, training is recognized as among the most promising. But the most effective type of training is still unclear. Training that uses reflexivity strategies could motivate healthcare professionals to engage in healthcare collaboration with patients and to be more open to diversity. Reflexivity is an exercise that leads learners to question their own values in order to better consider patient values and to support patients while least influencing their decisions. Training in shared decision-making using reflexivity strategies could enable a more patient-inclusive approach to shared decision-making and increase its implementation in health practice.

Objective:

In this secondary analysis of a 2018 Cochrane review of interventions for improving shared decision-making by healthcare professionals, we aimed to identify shared decision-making training programs that included reflexivity strategies and were assessed as effective. Secondly, we aimed to explore if further factors can be associated with or enhance their effectiveness.

Methods:

From the Cochrane review, we first extracted training programs that targeted healthcare professionals. Second, we developed a grid to explore potential for reflexivity by identifying training formats (interactive vs. unidirectional) and which interactive training programs used reflexivity strategies. Third, those identified were further categorized according to type of strategy (peer-to-peer group learning vs. self-appraisal individual learning). For each step of the processes, we identified the proportion of programs that are classified as effective by Cochrane (2018). This method allowed us to compare groups in terms of effectiveness. Finally, we examined other aspects such as interprofessional orientation or otherwise and the type of measurement used to see if each of them can affect judgement while evaluating the effectiveness of training using reflexivity strategies. In fact, since the peer-to-peer group learning strategy used some methods similar to interprofessional orientation (interaction and exchange between learners), we wanted to see if we would have similar results in term of effectiveness while examining programs using peer-to-peer group learning and those developed with an interprofessional orientation. For methodological rigor, the Cochrane review selected programs that were evaluated with a patient reported outcome measurement and/or observer reported outcome measurement. In this work, we wanted to examine if there is a type of measurement that was most often used in effective training programs.

Results:

Out of 31 training programs extracted, 24 (77%) were interactive (of which 42% were considered effective) and 7 (23%) were unidirectional (14% effective). A total of 7 of the 24 interactive programs included reflexivity strategies (43% effective), and 17 had no reflexivity strategies (41% effective). Among the 7 training programs with reflexivity strategies, 5 used a peer-to-peer group learning strategy (71%), among which 3 (60%) were effective; the other 2/7 (29%) used a self-appraisal individual learning strategy and none were effective. Programs with an interprofessional orientation made up 5 out of 31 (16%) of the training programs extracted, of which 3 (60%) were effective. Of the 26 out of 31 (84%) programs that did not have an interprofessional orientation, 8 (31%) were effective. Most programs considered effective (n=11/31) used observer-based measurements and 7/11 (63%).

Conclusions:

Our study appears to be the first to evaluate the effectiveness of shared decision-making training programs including reflexivity strategies. Its conclusions open promising avenues to enrich future shared decision-making training programs with reflexivity strategies. The grid developed here to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in shared decision-making training.