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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 4 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 9-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 1 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 9 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 9 SDM behaviors. Adjusted for the hierarchical study design and covariates, the mean RPAD score improvement was 1.68 points (95% CI, 1.33 to 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 4 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 a 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.

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.

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

Acknowledgments: The authors are grateful to additional members of the Patient Engagement Project who collected study observations and/or delivered the intervention: Poonam Hosamani, MD, clinical assistant professor, Department of Medicine, Stanford University School of Medicine, Stanford, California; Adeena Khan, MD, assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California; Lisa Shieh, MD, clinical professor, Department of Medicine, Stanford University School of Medicine, Stanford, California; and Lijia Xie, MD, hospitalist, Highland Hospital, Oakland, California).

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.

Correspondence should be addressed to Joan F. Hilton, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143-0560; email: Joan.Hilton@ucsf.edu.

© 2019 by the Association of American Medical Colleges