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Promoting Shared Decision-Making Behaviors During Inpatient Rounds

A Multimodal Educational Intervention

Harman, Stephanie M. MD; Blankenburg, Rebecca MD, MPH; Satterfield, Jason M. PhD; Monash, Brad MD; Rennke, Stephanie MD; Yuan, Patrick; Sakai, Debbie S. MD; Huynh, Eric; Chua, Ian MD; Hilton, Joan F. ScD, MPH for the Patient Engagement Project

doi: 10.1097/ACM.0000000000002715
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Purpose To estimate the effectiveness of a multimodal educational intervention to increase use of shared decision-making (SDM) behaviors by inpatient pediatric and internal medicine hospitalists and trainees at teaching hospitals at Stanford University and the University of California, San Francisco.

Method The 8-week Patient Engagement Project Study intervention, delivered at four services between November 2014 and January 2015, included workshops, campaign messaging, report cards, and coaching. For 12-week pre- and postintervention periods, clinician peers used the nine-point Rochester Participatory Decision-Making Scale (RPAD) to evaluate rounding teams’ SDM behaviors with patients during ward rounds. Eligible teams included a hospitalist and at least one trainee (resident, intern, medical student), in addition to nonphysicians. Random-effects models were used to estimate intervention effects based on RPAD scores that sum points on nine SDM behaviors per patient encounter.

Results In total, 527 patient encounters were scored during 175 rounds led by 49 hospitalists. Patient and team characteristics were similar across pre- and postintervention periods. Improvement was observed on all nine SDM behaviors. Adjusted for the hierarchical study design and covariates, the mean RPAD score improvement was 1.68 points (95% CI, 1.33–2.03; P < .001; Cohen d = 0.82), with intervention effects ranging from 0.7 to 2.5 points per service. Improvements were associated with longer patient encounters and a higher percentage of trainees per team.

Conclusions The intervention increased behaviors supporting SDM during ward rounds on four independent services. The findings recommend use of clinician-focused interventions to promote SDM adoption in the inpatient setting.

S.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.

Funding/Support: We gratefully acknowledge financial support from grant R25 AT006573, awarded to Dr. Satterfield by the National Institutes of Health National Center for Complementary and Integrative Health (formerly National Center for Complementary and Alternative Medicine) and Office of Behavioral and Social Sciences Research.

Other disclosures: None reported.

Ethical approval: Institutional review board approval to conduct the PEP Study was obtained from both the University of California, San Francisco and Stanford University.

Previous presentations: This study was presented at the Pediatric Academic Societies 2016 Annual Meeting (April 2016, Baltimore, Maryland), where it received the 2016 Academic Pediatric Association Ray E. Helfer Innovation in Medical Education Award. It also was presented at the Society of General Internal Medicine 2016 Annual Meeting, May 2016, Hollywood, Florida, and Learn Serve Lead 2016: The AAMC Annual Meeting, November 2016, Seattle, Washington.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A658.

The authors have informed the journal that they agree that both Stephanie Harman and Rebecca Blankenburg completed the intellectual and other work typical of the first author.

Correspondence should be addressed to Joan F. Hilton, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St., San Francisco, CA 94143; email: Joan.Hilton@ucsf.edu.

© 2019 by the Association of American Medical Colleges