- Patient and provider training courses may increase the efficacy of shared decision-making in multicultural behavioral health clinics, according to new research in JAMA Psychiatry.
Shared decision-making has been touted as an effective strategy for integrating the patient voice into treatment protocol. Through meaningful patient-provider communication and patient education, healthcare professionals can elicit patient preferences for care and make treatment decisions accordingly.
“However, few clinicians have the skills to encourage patient involvement or adjust to preferences,” the researchers noted, pointing to clinician deficiencies with minority populations. “Randomized clinical trials of SDM have mostly targeted primary care and have included few ethnic/racial minorities. Minority patients are less likely than white patients to state concerns, seek information, or feel trust, thereby missing opportunities to improve outcomes.”
Clinicians face their own barriers with respect to shared decision-making with minority patient populations. Providers may stereotype a patient, experience provider bias, or lack the skills needed to address power differentials.
DECIDE – decide the problem; explore the questions; close or open-ended questions; identify the who, why, or how of the problem; direct questions to your healthcare professional; enjoy a shared solution – is a patient and provider training program to prepare stakeholders for shared decision-making.
The program was developed with cultural and linguistic differences in mind, but has seldom seen experimentation with minority patient populations, the researchers reported. The team sought to better understand how DECIDE could improve shared decision-making and perceived care quality in behavioral healthcare practices in the Boston area.
The team tested a patient and provider intervention on 312 patients and their 74 providers.
“The clinician intervention consisted of a workshop and as many as six coaching telephone calls to promote communication and therapeutic alliance to improve SDM,” the researchers explained. “The three-session patient intervention sought to improve SDM and quality of care.”
The team split the participants into four test groups: patient and provider control group, patient intervention and provider control group, patient control and provider intervention group, and patient and provider intervention group.
Each group received a shared decision-making score from a third-party coder. They also reported their own perceptions of care quality and shared decision-making.
Overall, the DECIDE intervention positively influenced shared decision-making. Patient and provider pairs received higher coded scores when the provider underwent the intervention program.
They did not necessarily receive higher self-reported scores for shared decision-making. This may have been because providers are not able to distinguish the differences in their care when leveraging shared decision-making strategies.
“Clinicians may need to hear audiotaped sections before and after coaching to recognize their changes in attributional errors, perspective taking, and receptivity to collaboration and how these affect their patients,” the researchers explained. “Similarly, video training for patients in SDM could facilitate recognizing these behaviors.”
Notably, the provider intervention had a significant impact on shared decision-making on non-English-speaking patient populations, the research team said. This may have been because there was a larger opportunity for improvement with respect to non-English-speaking patients, who usually experience little to no shared decision-making in healthcare.
“The intervention may have a stronger effect on patient global evaluation of care in linguistically discordant patient-clinician relationships requiring greater clinician effort and a subjectively different, more apparent SDM experience for the patient,” the researchers pointed out. “Non-English-speaking patients may also have more cultural distance from English-speaking clinicians and, under distress, are less able to express preferences.”
The patient intervention did not have a significant impact on shared decision-making, but it did improve patient perceptions of quality care.
“The patient intervention did not teach patients about SDM but rather focused on asking questions, identifying resources, and communicating preferences. Preparing patients for SDM during the clinical session should be made explicit,” the researchers explained.
“The patient intervention increased perception of quality of care by increasing patient opportunities to voice concerns or topics through inquiry,” the research team continued.
The healthcare industry is increasingly leaning in a more patient-centric direction, requiring healthcare providers to better activate patients in their own care. Shared decision-making is a clinically proven method for doing so, but too few providers have a working knowledge for integrating the technique into clinical workflows.
“Results suggest that an adequate threshold of SDM training promotes a gradual philosophical transformation for clinicians, whereby patient preferences, choices, and agency come to the forefront, all of which are important components of achieving better health outcomes,” the researchers concluded.