Shared decision making coaching for behavioral health providers and patients / Margarita Alegria, Ora Nakash.

Format:

Book

Author/Creator:

Alegria, Margarita, author.

Nakash, Ora, author.

Language:

English

Subjects (All):

Medicine and psychology.

Physical Description:

1 online resource (1 PDF file (95 pages)) : illustrations

Place of Publication:

Washington (DC) : Patient-Centered Outcomes Research Institute (PCORI), 2020.

Summary:

BACKGROUND: Shared decision-making (SDM) in health care is a process in which both patients and providers are equal partners collaborating to make health care decisions. SDM improves outcomes and quality of care; yet, few providers actively facilitate SDM. To date, few randomized controlled trials (RCTs) to improve SDM have been conducted with ethnic/racial minorities and none have been tested in behavioral health care. OBJECTIVES: To test the effectiveness of the DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; and Enjoy a shared solution) patient and DECIDE provider coaching interventions for improving SDM and quality of care among an ethnically/racially diverse population. METHODS: We conducted a cross-level 2×2 RCT including clinicians at level 2 and patients (nested within clinicians) at level 1. We recruited participants (312 patients, 74 providers) starting in September 2013 and collected final data in September 2016 at 13 behavioral health clinics in Massachusetts. The provider intervention focused on promoting patient-centered communication as a pathway to improved SDM. It included a small group workshop and up to 6 individual coaching calls. The patient intervention sought to improve SDM and quality of care for patients in behavioral health care, independent of their clinical profile, and included 3 one-on-one sessions. Main outcome measures included blind coder-assessed SDM based on an audio-recorded clinical encounter, patient and provider SDM ratings, and patients' perception of quality of care (PoC). We conducted intent-to-treat and dosage analyses, followed by mediation and moderation analyses for patients in behavioral health care. RESULTS: The provider intervention significantly increased blind coder-assessed SDM (b = 4.52; SE, 2.17; P = .04); the clinical encounters of providers who received the SDM training intervention were rated 4.52 points higher on the OPTION ("observing patient involvement") scale of SDM, from 0 to 100 (mean, 33.0; SD, 14.43; Cohen d = 0.29). The training dosage analysis corroborated the intent-to-treat analysis, showing that greater provider training dosage significantly increased blind coder SDM (b = 12.01; SE, 3.72; P = .001; Cohen d = 0.78). We found no significant effect of the patient intervention on blind coder SDM or of the patient or provider intervention on patient- or provider-reported SDM. The patient intervention significantly increased PoC (b = 2.27; SE, 1.16; P = .049), such that intervention patients rated their care quality 2.27 points higher on a scale from 0 to 100 (mean, 89.9; SD, 12.0) as compared with the control group. Patient training dosage was significantly positively associated with PoC (b = 3.33; SE, 1.17; P = .01; Cohen d = 0.28). The interaction of patient and provider training dosage was also significantly associated with PoC (b = 7.40; SE, 3.56; P = .04; Cohen d = 0.62), indicating patients rated their quality of care 7 points higher when both obtained the recommended number of training sessions. Patient-centered communication and therapeutic alliance mediated the intervention effect on PoC. Finally, our moderation analyses suggested that the provider intervention had a stronger effect on PoC when patients and providers did not share the same primary language. CONCLUSIONS: The provider intervention improved SDM, with small to moderate effects. We observed the greatest improvement in perception of quality of care when both patients and providers obtained the recommended number of training sessions. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: We included only providers and patients who voluntarily participated in the study; thus, selection bias might have occurred. The results may not be applicable beyond behavioral health care settings.

Notes:

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