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Abstract

Objective:

Evaluation of the effect of the train-the-trainer programme ‘Fit for Shared Decision-Making’ on internal (team) and external (patient) participation in medical rehabilitation from a patient and staff perspective.

Design:

A multicentre, cluster-randomized controlled study.

Setting:

Eleven medical rehabilitation clinics, divided into intervention and control groups.

Subjects:

A staff and a patient survey were conducted pre- and post-intervention, plus a further patient survey six months later.

Intervention:

Train-the-trainer programme ‘Fit for Shared Decision-Making’ for interprofessional settings.

Main measures:

Each survey measured internal participation with a self-compiled six-item scale (Internal Participation Scale, IPS), and external participation by means of a nine-item Shared Decision-Making Questionnaire (SDM-Q-9) for the patients and for healthcare professionals.

Results:

Patient samples numbered 402 for the pre-, 463 for the post-intervention data collection period and 461 six months after the intervention. Patients’ appraisal of external participation (F_{period x group} (2) = 0.256, p=0.774, η²=0.000) showed no change, whereas internal participation (F_{period x group} (2) = 3.785, p=0.023, η²=0.007) showed a significant increase. A total of 195 healthcare professionals participated in the pre- and 168 in the post-intervention staff survey. Here external participation was significantly enhanced in the intervention group (F_{period x group} (1) = 4.893, p=0.028, η²=0.014).

Conclusions:

The train-the-trainer approach can be recommended for implementing internal and external participation in interprofessional settings such as medical rehabilitation clinics. However, there is a need for more intensive staff training for internal participation and an additional intervention for patients to achieve success in all aspects.

Keywords

Shared decision-making patient-centred care interprofessional team train-the-trainer programme cluster-randomized controlled study

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References

Koerner

. Interprofessional teamwork in medical rehabilitation: A comparison of multidisciplinary and interdisciplinary team models. Clin Rehabil 2010; 24: 745–755.

Lown

Kryworuchko

Bieber

. Continuing professional development for interprofessional teams supporting patients in healthcare decision making. J Interprof Care 2011; 25: 401–408.

Reeves

Russel

Zwarenstein

. Structuring communication relationships for interprofessional teamwork (SCRIPT): A Canadian initiative aimed at improving patient-centred care. J Interprof Care 2007; 21: 111–114.

Montori

Gafni

Charles

. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect 2006; 9: 25–36.

Bieber

Mueller

Blumenstiel

. A shared decision-making communication training programme for physicians treating fibromyalgia patients: effects of a randomized controlled trial. J Psychosom Res 2008; 64: 13–20.

Bieber

Nicolai

Hartmann

. Training physicians in shared decision-making – Who can be reached and what is achieved? Patient Educ Couns 2009; 77: 48–54.

Légaré

Politi

Drolet

. Training health professionals in shared decision-making: An international environmental scan. Patient Educ Couns 2012; 88: 159–169.

Loh

Simon

Wills

. The effects of a shared decision-making intervention in primary care of depression; a cluster-randomized controlled trial. Patient Educ Couns 2007; 67: 324–332.

Bovend’Eerdt

TJH

Botell

Wade

. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil 2009; 23: 352–361.

10.

Barnard

Cruice

Playford

. Strategies used in the pursuit of achievability during goal setting in rehabilitation. Qualitative Health Res 2010; 20: 239–250.

11.

Glattacker

Dudeck

Dibbelt

Quatmann

Greitemann

Jäckel

. Evaluation einer Intervention zur partizipativen Vereinbarung von Rehabilitationszielen bei Patienten mit chronischen Rückenschmerzen. Die Rehabilitation, 2012 . DOI: 10.1055/s-0032-1327724.

12.

Playford

Siegert

Levack

Freemann

. Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clin Rehab 2009; 23: 334–344.

13.

Rosewilliam

Roskell

Pandyan

. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehab 2011; 25: 501–514.

14.

Lemieux-Charles

McGuire

. What do we know about health care team effectiveness? A review of the literature. Med Care Res Rev 2006, 63: 263.

15.

O’Leary

Sehgal

Terrell

Williams

. For the high performance teams and the hospital of the future project team. Interdisciplinary teamwork in hospitals: A review and practical recommendations for improvement. J Hosp Med. Epub ahead of print 31 October 2011. DOI: 10.1002/jhm.970.

16.

. Teamwork and communication in healthcare. Edmonton: Canadian Patient Safety Institute, 2011.

17.

Bieber

Loh

Ringel

. Patient involvement in medical decisions. Manual for Shared Decision-Making [in German]. Freiburg: Universitaetsklinikum, 2007.

18.

Norrefalk

. How do we define multidisciplinary rehabilitation? J Rehab Med, 2003; 35: 100–102.

19.

Koerner

. A model of shared decision-making in medical rehabilitation [in German]. Die Rehabilitation 2009; 48: 160–165.

20.

Koerner

Ehrhardt

Steger

A-K

. Designing an interprofessional training program for shared decision-making. J Interprof Care 2013; 27: 146–154.

21.

Koerner

Ehrhardt

Steger

A-K

Bengel

. Interprofessional SDM train the-trainer program ‘‘Fit for SDM’’: Provider satisfaction and impact on participation Patient Educ Couns 2012; 89: 122–128.

22.

Koerner

Ehrhardt

Steger

A-K

. Development of an interprofessional train-the-trainer programme to implement shared decision-making in medical rehabilitation clinics [in German]. Die Rehabilitation 2011; 50: 331–339.

23.

Légaré

Stacey

. Shared decision-making: The implications for health care teams and practice. In Edwards

Elwyn

(eds) Shared decision-making in health care. Achieving evidence-based patient choice. New York: Oxford University Press, 2009, pp.23–28.

24.

Zacher

Felfe

Glander

. Learning in teams: Relationships between individual and team characteristics and the performance of multipliers [in German]. Zeitschrift fuer Arbeits- und Organisationspsychologie 2008; 52: 81–90.

25.

Oandasan

Reeves

. Key elements of interprofessional education. Part 2: Factors, processes and outcomes. J Interprof Care 2005; suppl.1: 39–48.

26.

Campbell

Stowe

Ozanne

. Interprofessional practice and decision support: An organizational framework applied to a mental health setting. J Interprof Care 2011; 25: 423–427.

27.

Visser

Wysmans

. Improving patient education by an in-service communication training for health care providers at a cancer ward: communication climate, patient satisfaction and the need of lasting implementation. Patient Educ Couns 2010; 78: 402–408.

28.

Col

Bozzuto

Kirkegaard

. Interprofessional education about shared decision making for patients in primary care settings. J Interprof Care 2011; 25: 209–415.

29.

Kriston

Scholl

Hoelzel

. The 9-item Shared Decision Making Questionnaire (shared decision-making-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 2010; 80: 94–99.

30.

Scholl

Kriston

Dirmaier

. Development and psychometric properties of the Shared Decision Making Questionnaire – physician version (shared decision-making-Q-Doc). Patient Educ Couns. Epub ahead of print 3 April 2012. DOI: 10.1016/j.pec.2012.03.005.

31.

Körner

Wirtz

. Development and psychometric properties of the team-scale for measuring interprofessional collaboration from a patient and health care professional perspective. BMC Health Services Research, in review.

32.

Taylor

Brown

Levack

. A pilot cluster randomized controlled trial of structured goal setting following stroke. Clin Rehabil 2012; 26: 327–338.

33.

Hox

. Multilevel analysis. Techniques and applications. 2nd ed. New York: Routledge, 2010.

34.

Hox

Roberts

(eds). Handbook of advanced multilevel analysis. New York: Routledge, 2011.

35.

Arranz

Ulla

Ramos

. Evaluation of a counseling training programme for nursing staff. Patient Educ Couns 2005; 56: 233–239.

36.

Stacey

Murray

Légaré

. Decision coaching to support shared decision-making: a framework, evidence, and implications for nursing practice, education, and policy. Worldv Evid-Based Nu 2008; 5: 25–35.

37.

Légaré

Ratté

Gravel

Graham

. Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professions’ perception. Patient Educ Couns 2008; 73: 526–535.

38.

Bieber

Mueller

Blumenstiel

. Long term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibomyalgia. A qualitative and quantitative 1-year follow-up of a randomized controlled trial. Patient Educ Couns 2006, 63: 357–366.

39.

Edwards

Elwyn

Hood

. Study steering group. Patient-based outcome results from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. Fam Pract 2004; 21: 347–354.

40.

Schectman

Schroth

Verme

Voss

. Randomized controlled trial of education and feedback for implementation. J Gen Intern Med 2003; 18: 773–780.

41.

Haskard

Williams

DiMatteo

. Physician and patient communication training in primary care: effects on participation and satisfaction. Health Psychol 2008; 27: 513–522.

42.

Harrington

Noble

Newman

. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns 2004; 52: 7–16.

43.

Harrington

Norling

Witte

. The effects of communication skills training on pediatricians’ and parents’ communication during “sick child” visits. Health Comm 2007; 21: 105–114.

44.

Street

Slee

Kalauokalani

. Improving physician-patient communication about cancer pain with tailored education-coaching intervention. Patient Educ Couns 2010; 80: 42–47.

45.

Pecukonis

Doyle

Leigh Bliss

. Reducing barriers to interprofessional training: Promoting interprofessional cultural competence. J Interprof Care 2008; 22(4): 417–428.

46.

D’Amour

Ferrada-Videla

San Martin Rodriguez

Beaulieu

. The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. J Interprof Care 2005; 20(Suppl.1): 116–131.

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A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation

Abstract

Objective:

Design:

Setting:

Subjects:

Intervention:

Main measures:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material