Shared decision-making training improves clinician communication with minority populations, allowing for patient preferences, choices, and agency to play a primary role in healthcare decisions, according to the results of a cross-level, 2×2 randomized clinical trial published in JAMA Psychiatry.
Margarita Alegria, PhD, from Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, and colleagues included clinicians at level 2 and patients, nested within clinicians, at level 1 from 13 Massachusetts behavioral health clinics. Clinicians were recruited starting September 1, 2013, and patients starting November 3, 2013. Data were collected until September 30, 2016, and analyzed on the basis of intention to treat.
The clinicians participated in a 12-hour DECIDE-PC workshop over the course of 2 to 3 days and received up to 6 coaching telephone calls to encourage communication and therapeutic alliance to improve shared decision making. Six coaching calls were considered the recommended “dose” for the intervention. Patients received three 60-minute sessions to improve shared decision making and quality of care. The program was assessed using patient perception of shared decision making and quality of care and clinician perception of shared decision making. Clinicians in the usual care (control) condition had sessions audio recorded and completed assessments, whereas patients with usual treatment completed 3 assessments and had a recorded clinical session.
The investigators randomly assigned 312 patients and 74 clinicians. Patient-clinician pairs were assigned to 1 of 4 groups: patient and clinician in the control condition, patient in the intervention and clinician in the control condition, patient in the control condition and clinician in the intervention, or patient and clinician both in the intervention.
The clinician intervention significantly increased shared decision making as rated by blinded coders, using the 12-item Observing Patient Involvement in Shared Decision Making instrument (P =.04), but not as assessed by clinician or patient. A dose-response was evident, as more clinician coaching sessions were significantly associated with increased shared decision making, as rated by blinded coders (P =.001). The patient intervention significantly increased patient perception of quality of care (P =.05), and there was a significant interaction between patient and clinician dosage (P=.04). The greatest benefit was found when both clinician and patient had obtained the recommended dosage of the intervention.
The researchers noted that the heterogeneous nature of the study sample, with participants speaking many diverse languages at different clinics with different coaches, makes these results more generalizable.
Alegria M, Nakash O, Johnson K, et al. Effectiveness of the DECIDE interventions on shared decision making and perceived quality of care on behavioral health with multicultural patients. A randomized clinical trial [published online February 21, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4585