Impact of a training program on gastroenterology health care professionals' patient-centered shared decision-making:...

Patient-centered care (PCC) and shared decision-making (SDM) are internationally recognized as the preferred approaches to patient care. However, implementation in daily clinical practice remains challenging as sustainable behavioral change requires a multifaceted approach. We developed and evaluated a training program consisting of an e-learning, skills training, deliberate practice and a group reflection session, aimed at improving gastroenterologists' patient-centered attitudes and SDM skills.

Before and after training, we assessed preferred and self-reported actual patient care behavior (disease-centered vs. patient-centered) by visual analogue scale (VAS) and attitudes towards PCC with the Patient-Practitioner Orientation Scale (PPOS). Open-ended questions exploring participants' concepts of patient-centeredness were analyzed using thematic analysis. Recorded patient consultations were analyzed using the OPTION⁵ and Four Habits Coding Scale (4HCS) to evaluate observed SDM and patient-centered communication behaviors.

Twenty-three gastroenterology healthcare professionals completed the training program, showing significant improvements in attitudes towards patient-centeredness (baseline mean total PPOS 4.73 [SD 0.37], 95% CI of difference 0.04-0.44) and self-reported patient-centered behavior (baseline mean VAS 49 [18], 95% CI of difference 6.08-23.81) after the intervention. High levels of patient-centered behavior and SDM skills were observed in recorded consultations (mean 4HCS 72 [12], mean OPTION⁵ 44 [16]). Thematic analysis of responses to open-ended questions highlighted the relationship between healthcare provider (HCP) and patient as a core foundation for PCC, emphasizing trust, clear communication, and understanding patients' context. After the training, participants described increased attention to eliciting patients' values and preferences and explicitly acknowledging decisions to be made.

A dedicated training program increased gastroenterology professionals' patient-centered attitude and application of patient-centered SDM skills. These findings support the use of dedicated training to facilitate the implementation of PCC and SDM in clinical gastroenterology practice.