The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic
Abstract Background Care decision discussions are intended to align treatment with the patient’s wishes, goals and values. To overcome the numerous barriers to such discussions, physicians as well as patients need tailored support. We evaluate the effect of a physicians’ training and a conversation...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08901-7 |
| _version_ | 1797977517658734592 |
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| author | Saskia Briedé Maria A. de Winter Tessa C. van Charldorp Karin A. H. Kaasjager |
| author_facet | Saskia Briedé Maria A. de Winter Tessa C. van Charldorp Karin A. H. Kaasjager |
| author_sort | Saskia Briedé |
| collection | DOAJ |
| description | Abstract Background Care decision discussions are intended to align treatment with the patient’s wishes, goals and values. To overcome the numerous barriers to such discussions, physicians as well as patients need tailored support. We evaluate the effect of a physicians’ training and a conversation aid for patients about care decisions on patient and physician outcomes. Methods At the internal medicine outpatient clinic of the University Medical Centre Utrecht, a 1:1 randomized, parallel-group study (patient conversation aid) was combined with a pre-post intervention (physicians’ training) design. Primary outcome was patient satisfaction, secondary outcomes were patient-doctor relationship, shared-decision-making, doctor preparedness and patient appreciation of the conversation aid. Results Between October 2018 and February 2020 11 physicians (36% residents, 73% female) and 185 patients (median age 58 years (interquartile range (IQR) 50–68), 60% male) participated. Only 28% of the patients reported a care decision discussion during the consultation. We found no effect of the interventions on patient satisfaction (effect sizes -0.14 (95% confidence interval (CI) -0.56–0.27) for conversation aid; 0.04 (95% CI -0.40–0.48) for physician’s training), nor on the patient-doctor relationship or shared-decision-making. However, physicians felt more prepared to discuss care decisions after training (median 3 (IQR 1–4) vs 1 (IQR 0–3), p = 0.015). Patients assessed the conversation aid informative and gave an overall mark of median 7 (IQR 7–8). Conclusions First steps towards fruitful discussions about care decisions were made: patients considered the conversation aid informative and physicians felt better prepared to discuss care decisions after training. The low number of care decision conversations patients reported shows exactly how important it is to focus on interventions that facilitate these discussions, for both the patient and physician. Further work needs to be done to establish the best way to empower patients and physicians. Trial registration Dutch trial register, trial 6998 (NTR 7188), registered 04/05/2018, https://www.trialregister.nl/trial/6998 . |
| first_indexed | 2024-04-11T05:08:13Z |
| format | Article |
| id | doaj.art-1725b5f78bb14034ae48409e1e48c9c9 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T05:08:13Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-1725b5f78bb14034ae48409e1e48c9c92022-12-25T12:09:21ZengBMCBMC Health Services Research1472-69632022-12-0122111010.1186/s12913-022-08901-7The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinicSaskia Briedé0Maria A. de Winter1Tessa C. van Charldorp2Karin A. H. Kaasjager3Department of Internal Medicine and Dermatology, University Medical Centre UtrechtDepartment of Internal Medicine and Dermatology, University Medical Centre UtrechtDepartment of Languages, Literature and Communication, Faculty of Humanities, Utrecht UniversityDepartment of Internal Medicine and Dermatology, University Medical Centre UtrechtAbstract Background Care decision discussions are intended to align treatment with the patient’s wishes, goals and values. To overcome the numerous barriers to such discussions, physicians as well as patients need tailored support. We evaluate the effect of a physicians’ training and a conversation aid for patients about care decisions on patient and physician outcomes. Methods At the internal medicine outpatient clinic of the University Medical Centre Utrecht, a 1:1 randomized, parallel-group study (patient conversation aid) was combined with a pre-post intervention (physicians’ training) design. Primary outcome was patient satisfaction, secondary outcomes were patient-doctor relationship, shared-decision-making, doctor preparedness and patient appreciation of the conversation aid. Results Between October 2018 and February 2020 11 physicians (36% residents, 73% female) and 185 patients (median age 58 years (interquartile range (IQR) 50–68), 60% male) participated. Only 28% of the patients reported a care decision discussion during the consultation. We found no effect of the interventions on patient satisfaction (effect sizes -0.14 (95% confidence interval (CI) -0.56–0.27) for conversation aid; 0.04 (95% CI -0.40–0.48) for physician’s training), nor on the patient-doctor relationship or shared-decision-making. However, physicians felt more prepared to discuss care decisions after training (median 3 (IQR 1–4) vs 1 (IQR 0–3), p = 0.015). Patients assessed the conversation aid informative and gave an overall mark of median 7 (IQR 7–8). Conclusions First steps towards fruitful discussions about care decisions were made: patients considered the conversation aid informative and physicians felt better prepared to discuss care decisions after training. The low number of care decision conversations patients reported shows exactly how important it is to focus on interventions that facilitate these discussions, for both the patient and physician. Further work needs to be done to establish the best way to empower patients and physicians. Trial registration Dutch trial register, trial 6998 (NTR 7188), registered 04/05/2018, https://www.trialregister.nl/trial/6998 .https://doi.org/10.1186/s12913-022-08901-7Care decisionsTreatment limitationsOutpatient clinicProvider-patient communicationCommunication trainingPatient education |
| spellingShingle | Saskia Briedé Maria A. de Winter Tessa C. van Charldorp Karin A. H. Kaasjager The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic BMC Health Services Research Care decisions Treatment limitations Outpatient clinic Provider-patient communication Communication training Patient education |
| title | The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic |
| title_full | The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic |
| title_fullStr | The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic |
| title_full_unstemmed | The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic |
| title_short | The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic |
| title_sort | effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic |
| topic | Care decisions Treatment limitations Outpatient clinic Provider-patient communication Communication training Patient education |
| url | https://doi.org/10.1186/s12913-022-08901-7 |
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