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Promoting Shared Decision-Making Behaviors During Inpatient Rounds: A Multimodal Educational Intervention
Stephanie M Harman1, Rebecca Blankenburg, Jason M Satterfield
1S.M. Harman is clinical associate professor, Department of Medicine, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-1356-9314. R. Blankenburg is clinical associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-1938-6113. J.M. Satterfield is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-2765-3701. B. Monash is associate professor, Departments of Medicine and Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California. S. Rennke is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-2004-8496. P. Yuan is research assistant, Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8472-0739. D.S. Sakai is clinical associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-2345-9856. E. Huynh is an MBA student, University of California, Berkeley, Haas School of Business, Berkeley, California. I. Chua is assistant professor, Department of Pediatrics, Children's National Medical Center, Washington, D.C., and clinical instructor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California. J.F. Hilton is professor, Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2452-4274.
A multimodal educational intervention significantly improved shared decision-making (SDM) behaviors among hospitalists and trainees during inpatient ward rounds. This clinician-focused approach enhances patient-centered care in teaching hospitals.
Area of Science:
- Medical Education
- Health Services Research
- Patient Engagement
Background:
- Shared decision-making (SDM) is crucial for patient-centered care.
- Implementing SDM in inpatient settings, particularly in teaching hospitals, presents unique challenges.
- Effective interventions are needed to enhance SDM behaviors among clinicians and trainees.
Purpose of the Study:
- To evaluate the effectiveness of a multimodal educational intervention designed to increase SDM behaviors.
- To assess the impact of the intervention on hospitalists and trainees in pediatric and internal medicine at academic medical centers.
- To measure changes in SDM behaviors during inpatient ward rounds.
Main Methods:
- An 8-week intervention (Patient Engagement Project Study) involving workshops, messaging, report cards, and coaching was implemented.
- Clinician peers used the Rochester Participatory Decision-Making Scale (RPAD) to assess SDM behaviors during 12-week pre- and postintervention periods.
- Random-effects models analyzed RPAD scores from 527 patient encounters across 175 rounds.
Main Results:
- The intervention led to a significant improvement in all nine measured SDM behaviors.
- The mean RPAD score increased by 1.68 points (P < .001), indicating a substantial effect (Cohen d = 0.82).
- Improvements were associated with longer patient encounters and a higher proportion of trainees on the rounding team.
Conclusions:
- The multimodal educational intervention successfully enhanced SDM behaviors during inpatient ward rounds.
- Clinician-focused interventions are recommended for promoting SDM adoption in hospital settings.
- This study provides evidence for effective strategies to improve shared decision-making in academic medical centers.
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