26 Chapter 2 Training content: SDM elements addressed in training In our assessment of training content, we evaluated whether the training addressed key SDM elements derived from the ‘talk model’ or ‘three talk model by Elwyn and others. [20, 21] This model integrates various previously published SDM models and comprises ‘choice talk,’ ‘option talk,’ and ‘decision talk’. [20, 21] Stiggelbout and others further refined this model into four steps. [6] The first step involves the clinician ‘setting the stage’ at the beginning of the conversation by informing the patient about the decision-making process and their active role. The second step pertains ‘discussing options’, which corresponds to Elwyn’s ‘option talk’, and encompasses the explanation of the advantages and disadvantages of each available option. The third and fourth steps align with Elwyn’s ‘decision talk’, with the third step focusing on ‘discussing preferences,’ where the healthcare professional actively elicits and discusses the patient’s preferences, and the fourth element concerning ‘making a decision,’ which can be either a joint decision or dependent on the patient’s preference for their role in decisionmaking. [6] Our evaluation framework followed this four-step approach, resulting in the four SDM elements in our evaluation framework. Training characteristics: Critical elements for effective skills-transfer addressed in training To define the criteria for high-quality training characteristics conducive to effective skillstransfer for our evaluation framework, we relied on the results of the previously mentioned overview of systematic reviews by Berkhof and others. [19] According to this overview, effective training programs should be learner-centered, incorporate participants’ practice examples or experiences, and include opportunities for skill practice. Ideally, the training duration should be a whole day or longer. Effective training methods include role-play, feedback on practical training components, and small group discussions. [19] Therefore, our evaluation framework incorporated five quality criteria for effective skills transfer: 1) training duration of approximately a whole day or longer, 2) learner-centered training, and the use of 3) role-play, 4) feedback and 5) small group discussions as training methods. Although not explicitly incorporated into our evaluation framework, study results will report on four additional training characteristics from Berkhof’s study. These characteristics were added to the study results to enhance the overall understanding of the training interventions, although their effectiveness in skill transfer has not been proven. [19] The extra training descriptors encompassed (1) any form of discussion, (2) an oral presentation, (3) modelling (e.g., demonstration of SDM skills), and (4) the provision of written information. Data analysis For the purpose of reporting, study characteristics were systematically charted and presented in a tabular format. Due to heterogeneity in study designs and reported effects, a meta-analysis was not conducted. [31] Instead, we used descriptive statistics in a narrative synthesis to summarize the study results. We examined the relationship between study quality and effective teaching strategies by calculating the Spearman’s correlation coefficient between MERSQI scores and the count of effective training elements. We also compared studies meeting our criteria for high
RkJQdWJsaXNoZXIy MTk4NDMw