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Embedding an Education Intervention about Shared Decision Making into an RCT: Ensuring competency and fidelity.

Amy B Zelenski1, Karlie Haug2, Kyle J Bushaw2

  • 1Department of Medicine, University of Wisconsin, Madison, WI, USA.

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|February 13, 2024
PubMed
Summary

Nephrology clinicians successfully learned the Best Case/Worst Case Communication intervention for discussing dialysis initiation with patients. This study demonstrates a method for real-time evaluation of communication intervention adherence in clinical trials.

Keywords:
Communication educationKidney diseaseShared decision-making

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Area of Science:

  • Nephrology
  • Medical Education
  • Clinical Communication

Background:

  • Dialysis initiation decisions for patients with life-limiting illnesses require sensitive communication.
  • Effective communication strategies are crucial for shared decision-making in end-stage renal disease.
  • The Best Case/Worst Case Communication intervention aims to improve these discussions.

Purpose of the Study:

  • To evaluate the training outcomes of nephrology clinicians using the Best Case/Worst Case Communication intervention.
  • To assess intervention competency, fidelity, and adherence during a randomized clinical trial.
  • To describe the application of this intervention in discussions about dialysis initiation.

Main Methods:

  • Sixty-eight nephrologists were enrolled across ten sites and randomized to intervention or control groups.
  • Training focused on the Best Case/Worst Case Communication intervention for dialysis initiation discussions.
  • Fidelity and adherence were measured using completed graphic aids from patient encounters.

Main Results:

  • 34 of 36 trained nephrologists achieved competence in the intervention.
  • A 73% return rate of graphic aids was achieved in the intervention arm.
  • Intervention fidelity scores indicated complete element adherence throughout the study.

Conclusions:

  • The Best Case/Worst Case Communication intervention can be effectively taught to clinicians within a randomized clinical trial.
  • This study provides a strategy for real-time evaluation of communication intervention adherence.
  • Successful implementation supports improved patient-clinician discussions regarding dialysis and prognosis.