April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Comprehensive Patient-centered Care: An Assessment of Family Medicine Residents’ Shared Decision-Making Skills
Rationale: The American Academy of Family Physicians advocate health promotion and disease prevention through implementation of comprehensive care involving consideration of patients’ physical, social, and mental well-being. Family Medicine Residents are required by the Accreditation Council for Graduate Medical Education to achieve competencies in shared decision-making, which requires communication training. Communication curriculum is not often incorporated in medical schools and residency programs; if it is present, it appears briefly in lectures. Limited research is conducted on the evaluation process of peer feedback regarding family medicine residents’ shared decision-making skills (SDMS). Method: A multidisciplinary team developed a quality improvement workshop regarding diabetes prevention for a rural-missioned family medicine residency program. Due to the residency safety precautions secondary to the COVID-19 pandemic, eight postgraduate year-2 (PGY-2) residents participated in a two-hour virtual SDMS workshop delivered over Zoom. Residents worked in mock patient-provider pairs. Qualtrics online survey software was used to provide anonymous feedback post-workshop. Residents’ SDMS were evaluated using the previously validated (Cronbach’s alpha = 0.90) nine-item Shared Decision Making Questionnaire (SDM-Q-9). The SDM-Q-9 assessed incorporation of clear communication strategies and inclusion of patient preferences using a six-point Likert scale (1=strongly disagree; 6=completely agree; Kriston et al., 2010). Residents’ perception of their communication skills (i.e., confidence using SDMS during future in-person and Zoom appointments; willingness to change communication tactics for future appointments) post-workshop were also evaluated using 10 items measured on a five-point Likert scale (1=strongly disagree; 5=strongly agree). Results: Over half (63.6%) completely agreed that their mock provider: 1) included their preferences, 2) explained the advantages/disadvantages of treatment, 3) thoroughly explained their condition, 4) selected a treatment option together, and 5) reached a final agreement. However, 9.1% of mock patients somewhat agreed that their mock provider: 1) asked for their preference, 2) mentioned different treatment options existed, and 3) thoroughly provided guidance during the consultation. Despite most residents displaying SDMS, very few perceived the workshop as effective. Only 10% agreed: 1) their confidence in their overall SDMS increased, 2) their confidence in using SDMS during Telemedicine appointments increased, and 3) their confidence in using SDMS during in-person consultations increased. Implications: Although most mock patients supported their mock providers’ communication strategies, cognitive biases could have occurred from prior medical knowledge, familiarity among peers, and limited training on how to assess competencies accurately. Distributed high scores may indicate the need for actual patients to serve as the evaluators to determine whether appropriate communication techniques are utilized for tailored treatment plans. A small percentage of the mock providers agreed their SDMS improved, which denotes the need for further evaluation of how to format and deliver activities to increase residents’ SDMS. Residency programs should consider implementing multiple workshops and assessing SDMS among PGY 1 interns, PGY 2 residents, and PGY 3 residents to identify areas of improvement. Further investigation is needed to improve providers’ communication strategies for implementation of sufficient comprehensive, patient-centered care.