Assessment of medical students’ shared decision-making skills in simulated physician-patient encounters

2020 ◽  
Vol 103 (3) ◽  
pp. 500-504
Author(s):  
Alexander Waschwill ◽  
Anja Bittner ◽  
Sigrid Harendza
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Physician Patient

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

2020 ◽  
Author(s):  
Paul Muleli Kioko ◽  
Pablo Requena Meana
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Intellectual Ability ◽  
Medical Decision ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Good Healing ◽  
The Right ◽  
Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

Physician–patient interaction and medication adherence in lupus nephritis

Lupus ◽  
2020 ◽  
Vol 29 (10) ◽  
pp. 1168-1178
Author(s):  
Sofia Georgopoulou ◽  
Louise Nel ◽  
Shirish R Sangle ◽  
David P D’Cruz
Keyword(s):  
Decision Making ◽  
Medication Adherence ◽  
Lupus Nephritis ◽  
Shared Decision Making ◽  
Interpersonal Trust ◽  
Shared Decision ◽  
Patient Interaction ◽  
Physician Patient ◽  
The Relationship

Objective The quality of physician–patient interaction can have a significant impact on medication adherence. Little is known about this relationship in patients with lupus nephritis. Methods A cross-sectional, quantitative study. Data collected included demographics, current medication, systemic lupus erythematosus disease activity index, medication adherence, beliefs about medicines, shared decision-making, patient–doctor depth of relationship, patient–doctor quality of relationship, interpersonal trust in a physician and illness perceptions. Results Ninety-eight patients with lupus nephritis completed the questionnaires. Logistic regression indicated that medication adherence was significantly predicted by (a) interpersonal trust in a physician (B = 0.85, Wald 3.94, 95% confidence interval (CI) 1.01, 5.44; P = 0.05); (b) timeline cyclical (B = –0.89, Wald 4.95, 95% CI 0.19, 0.90; P < 0.05) and beliefs about the necessity of medicines (B = 0.75, Wald 4.14, 95% CI 1.03, 4.38; P < 0.05). Mediation analysis showed that beliefs about the necessity of medicines significantly mediated the relationship between trust and medication adherence when adjusted for age (B = 0.48, 95% CI 0.06, 1.08; P < 0.01). A further mediation analysis showed that patient–doctor depth of relationship (B = 0.05, 95% CI 0.01, 0.09; P < 0.001), shared decision-making (B = 0.07, 95% CI 0.01, 0.13; P < 0.001) and patient–doctor quality of relationship (B = 0.08, 95% CI 0.01, 0.16; P < 0.001) significantly mediated the relationship between illness coherence and interpersonal trust in a physician. Conclusion The findings highlighted two key elements: (a) the importance of trust in relation to medication adherence; and (b) a good understanding of patients’ illness is linked to a better relationship with their doctor and greater participation in shared decision-making which is associated with increased trust. Tailored psycho-educational interventions could contribute to improving the patient–doctor relationship quality, trust and increased shared decision-making, which, in turn, might improve medication adherence in patients with lupus nephritis.

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