背景:通过医疗保健专业人员与患者之间的协作,共享决策(SDM)导致更好的医疗保健流程。培训被公认为是卫生保健专业人员促进SDM的有前途的干预措施。然而,最有效的培训类型仍不清楚。Reflexivity是一种使医疗保健专业人员质疑自己的价值观的练习,以便更好地考虑患者的价值观并支持患者,同时对他们的决定影响最小。使用反身性策略的培训可以激励他们参与SDM,并对多样性更加开放。
目标:在对2018年Cochrane对卫生保健专业人员改善SDM的干预措施进行的二次分析中,我们旨在确定包括反身性策略的SDM培训计划,并被评估为有效.此外,我们旨在探讨进一步的因素是否可以与它们的有效性相关或增强它们的有效性。
方法:从Cochrane综述来看,我们首先提取了针对医疗保健专业人员的培训计划。第二,我们开发了一个网格来帮助识别使用自反性策略的培训计划。第三,根据所使用的策略类型对已确定的对象进行进一步分类.在每一步,我们确定了Cochrane综述(2018年)分类为有效的项目的比例,以便我们可以比较其有效性.此外,我们想看看使用对等小组学习的程序和具有跨专业取向的程序之间的有效性是否相似。最后,Cochrane综述选择了使用患者报告或观察者报告结局测量进行评估的项目.我们检查了这些测量中哪些最常用于有效的培训计划。
结果:在提取的31个训练计划中,24(77%)是互动的,其中10人(42%)被认为是有效的。在这31个项目中,7(23%)是单向的,其中1人(14%)被认为是有效的。在24个互动节目中,7(29%)包括反身性策略。在7个具有反身性策略的培训计划中,5(71%)使用对等小组学习策略,其中3人(60%)是有效的;另外2人(29%)使用自我评估的个人学习策略,两者都没有效果。在提取的31个培训项目中,5个(16%)项目有跨专业方向,其中3个(60%)有效;31个项目中的其余26个(84%)没有跨专业指导,其中8人(31%)有效。最后,31个程序中有12个(39%)使用基于观察者的测量,其中超过一半(7/12,58%)有效。
结论:我们的研究首次评估了包含反身性策略的SDM培训计划的有效性。其结论为通过反身性策略丰富未来的SDM培训计划开辟了道路。网格开发是为了确定使用反身性策略的培训计划,当进一步测试和验证时,可以指导未来在SDM培训中对自反性组件的评估。
BACKGROUND: Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity.
OBJECTIVE: In this secondary analysis of a 2018 Cochrane
review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness.
METHODS: From the Cochrane
review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane
review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane
review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs.
RESULTS: Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included
reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective.
CONCLUSIONS: Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.