Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial
Background Risk communication is a core aspect of a physician’s work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management o...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2020-02, Vol.35 (2), p.473-480 |
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| creator | Koch, Cora Dreimüller, Nadine Weißkircher, Janosch Deis, Nicole Gaitzsch, Eva Wagner, Stefanie Stoll, Marlene Bäßler, Franziska Lieb, Klaus Jünger, Jana |
| description | Background
Risk communication is a core aspect of a physician’s work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI).
Objective
To evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants’ risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions.
Design
A rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers.
Participants
Sixty-three medical students in their fourth or fifth year.
Interventions
Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.
Main Measures
Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).
Key Results
Participants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen’s
d
of 2.35 (95% confidence interval (CI) 1.62 to 3.01,
p
< 0.01) and of 1.83 (CI 1.13 to 2.47,
p
< 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (
d
between 0.91 and 2.04 (
p
< 0.001)).
Conclusions
Our results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge.
Trial Registration:
The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890. |
| doi_str_mv | 10.1007/s11606-019-05420-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7018798</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2354614922</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-720784f94fe63a179febf4e7a1bfdd81941d375c43fde4b5c172e8ee56b5a5d43</originalsourceid><addsrcrecordid>eNp9kUtv1DAUhS0EokPhD7BAlth0E-pXYocFEpryGKkIqQxry3GuZ9wm9mAnU8Gvx2Xa8liwupbud8691weh55S8ooTI00xpQ5qK0LYitWCkun6AFrRmdUVFKx-iBVFKVEpycYSe5HxJCOWMqcfoiFPFOCftAu3XYOzWhw1exuAGb6eMo8OrMEGCPGETevxlaxL0-Ayszz6G6pO5uhFMEa_GXYp7wBc-XxWDcZyDt2Yq0Gts8EURx9H_KNpiPqU4DOW5Tt4MT9EjZ4YMz27rMfr6_t16-bE6__xhtXx7XlkhxVRJRqQSrhUOGm6obB10ToA0tHN9r2graM9lbQV3PYiutlQyUAB109Wm7gU_Rm8Ovru5G6G3UNYwg94lP5r0XUfj9d-d4Ld6E_daEqpkq4rBya1Bit_m8iN69NnCMJgAcc6acSZaylQrC_ryH_QyzimU8wpVi6aEwlih2IGyKeacwN0vQ4m-iVUfYtUlVv0rVn1dRC_-PONecpdjAfgByKUVNpB-z_6P7U_DabBl</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2354614922</pqid></control><display><type>article</type><title>Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><creator>Koch, Cora ; Dreimüller, Nadine ; Weißkircher, Janosch ; Deis, Nicole ; Gaitzsch, Eva ; Wagner, Stefanie ; Stoll, Marlene ; Bäßler, Franziska ; Lieb, Klaus ; Jünger, Jana</creator><creatorcontrib>Koch, Cora ; Dreimüller, Nadine ; Weißkircher, Janosch ; Deis, Nicole ; Gaitzsch, Eva ; Wagner, Stefanie ; Stoll, Marlene ; Bäßler, Franziska ; Lieb, Klaus ; Jünger, Jana</creatorcontrib><description>Background
Risk communication is a core aspect of a physician’s work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI).
Objective
To evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants’ risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions.
Design
A rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers.
Participants
Sixty-three medical students in their fourth or fifth year.
Interventions
Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.
Main Measures
Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).
Key Results
Participants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen’s
d
of 2.35 (95% confidence interval (CI) 1.62 to 3.01,
p
< 0.01) and of 1.83 (CI 1.13 to 2.47,
p
< 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (
d
between 0.91 and 2.04 (
p
< 0.001)).
Conclusions
Our results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge.
Trial Registration:
The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-019-05420-w</identifier><identifier>PMID: 31823309</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Clinical decision making ; Clinical trials ; Communication ; Confidence intervals ; Conflict of Interest ; Conflicts of interest ; Curricula ; Curriculum ; Decision making ; Decision Making, Shared ; Diagnostic systems ; Female ; Health care facilities ; Health risk assessment ; Humans ; Internal Medicine ; Intervention ; Male ; Medical students ; Medicine ; Medicine & Public Health ; Original Research ; Patients ; Pharmaceutical industry ; Physicians ; Randomization ; Risk communication ; Risk management ; Students, Medical ; Therapeutic applications ; Video communication</subject><ispartof>Journal of general internal medicine : JGIM, 2020-02, Vol.35 (2), p.473-480</ispartof><rights>The Author(s) 2019</rights><rights>Journal of General Internal Medicine is a copyright of Springer, (2019). All Rights Reserved. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-720784f94fe63a179febf4e7a1bfdd81941d375c43fde4b5c172e8ee56b5a5d43</citedby><cites>FETCH-LOGICAL-c474t-720784f94fe63a179febf4e7a1bfdd81941d375c43fde4b5c172e8ee56b5a5d43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018798/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018798/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,41487,42556,51318,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31823309$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koch, Cora</creatorcontrib><creatorcontrib>Dreimüller, Nadine</creatorcontrib><creatorcontrib>Weißkircher, Janosch</creatorcontrib><creatorcontrib>Deis, Nicole</creatorcontrib><creatorcontrib>Gaitzsch, Eva</creatorcontrib><creatorcontrib>Wagner, Stefanie</creatorcontrib><creatorcontrib>Stoll, Marlene</creatorcontrib><creatorcontrib>Bäßler, Franziska</creatorcontrib><creatorcontrib>Lieb, Klaus</creatorcontrib><creatorcontrib>Jünger, Jana</creatorcontrib><title>Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Risk communication is a core aspect of a physician’s work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI).
Objective
To evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants’ risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions.
Design
A rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers.
Participants
Sixty-three medical students in their fourth or fifth year.
Interventions
Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.
Main Measures
Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).
Key Results
Participants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen’s
d
of 2.35 (95% confidence interval (CI) 1.62 to 3.01,
p
< 0.01) and of 1.83 (CI 1.13 to 2.47,
p
< 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (
d
between 0.91 and 2.04 (
p
< 0.001)).
Conclusions
Our results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge.
Trial Registration:
The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.</description><subject>Adult</subject><subject>Clinical decision making</subject><subject>Clinical trials</subject><subject>Communication</subject><subject>Confidence intervals</subject><subject>Conflict of Interest</subject><subject>Conflicts of interest</subject><subject>Curricula</subject><subject>Curriculum</subject><subject>Decision making</subject><subject>Decision Making, Shared</subject><subject>Diagnostic systems</subject><subject>Female</subject><subject>Health care facilities</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intervention</subject><subject>Male</subject><subject>Medical students</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research</subject><subject>Patients</subject><subject>Pharmaceutical industry</subject><subject>Physicians</subject><subject>Randomization</subject><subject>Risk communication</subject><subject>Risk management</subject><subject>Students, Medical</subject><subject>Therapeutic applications</subject><subject>Video communication</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUtv1DAUhS0EokPhD7BAlth0E-pXYocFEpryGKkIqQxry3GuZ9wm9mAnU8Gvx2Xa8liwupbud8691weh55S8ooTI00xpQ5qK0LYitWCkun6AFrRmdUVFKx-iBVFKVEpycYSe5HxJCOWMqcfoiFPFOCftAu3XYOzWhw1exuAGb6eMo8OrMEGCPGETevxlaxL0-Ayszz6G6pO5uhFMEa_GXYp7wBc-XxWDcZyDt2Yq0Gts8EURx9H_KNpiPqU4DOW5Tt4MT9EjZ4YMz27rMfr6_t16-bE6__xhtXx7XlkhxVRJRqQSrhUOGm6obB10ToA0tHN9r2graM9lbQV3PYiutlQyUAB109Wm7gU_Rm8Ovru5G6G3UNYwg94lP5r0XUfj9d-d4Ld6E_daEqpkq4rBya1Bit_m8iN69NnCMJgAcc6acSZaylQrC_ryH_QyzimU8wpVi6aEwlih2IGyKeacwN0vQ4m-iVUfYtUlVv0rVn1dRC_-PONecpdjAfgByKUVNpB-z_6P7U_DabBl</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Koch, Cora</creator><creator>Dreimüller, Nadine</creator><creator>Weißkircher, Janosch</creator><creator>Deis, Nicole</creator><creator>Gaitzsch, Eva</creator><creator>Wagner, Stefanie</creator><creator>Stoll, Marlene</creator><creator>Bäßler, Franziska</creator><creator>Lieb, Klaus</creator><creator>Jünger, Jana</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200201</creationdate><title>Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial</title><author>Koch, Cora ; Dreimüller, Nadine ; Weißkircher, Janosch ; Deis, Nicole ; Gaitzsch, Eva ; Wagner, Stefanie ; Stoll, Marlene ; Bäßler, Franziska ; Lieb, Klaus ; Jünger, Jana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-720784f94fe63a179febf4e7a1bfdd81941d375c43fde4b5c172e8ee56b5a5d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Clinical decision making</topic><topic>Clinical trials</topic><topic>Communication</topic><topic>Confidence intervals</topic><topic>Conflict of Interest</topic><topic>Conflicts of interest</topic><topic>Curricula</topic><topic>Curriculum</topic><topic>Decision making</topic><topic>Decision Making, Shared</topic><topic>Diagnostic systems</topic><topic>Female</topic><topic>Health care facilities</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intervention</topic><topic>Male</topic><topic>Medical students</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research</topic><topic>Patients</topic><topic>Pharmaceutical industry</topic><topic>Physicians</topic><topic>Randomization</topic><topic>Risk communication</topic><topic>Risk management</topic><topic>Students, Medical</topic><topic>Therapeutic applications</topic><topic>Video communication</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koch, Cora</creatorcontrib><creatorcontrib>Dreimüller, Nadine</creatorcontrib><creatorcontrib>Weißkircher, Janosch</creatorcontrib><creatorcontrib>Deis, Nicole</creatorcontrib><creatorcontrib>Gaitzsch, Eva</creatorcontrib><creatorcontrib>Wagner, Stefanie</creatorcontrib><creatorcontrib>Stoll, Marlene</creatorcontrib><creatorcontrib>Bäßler, Franziska</creatorcontrib><creatorcontrib>Lieb, Klaus</creatorcontrib><creatorcontrib>Jünger, Jana</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium 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Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koch, Cora</au><au>Dreimüller, Nadine</au><au>Weißkircher, Janosch</au><au>Deis, Nicole</au><au>Gaitzsch, Eva</au><au>Wagner, Stefanie</au><au>Stoll, Marlene</au><au>Bäßler, Franziska</au><au>Lieb, Klaus</au><au>Jünger, Jana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>35</volume><issue>2</issue><spage>473</spage><epage>480</epage><pages>473-480</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Risk communication is a core aspect of a physician’s work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI).
Objective
To evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants’ risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions.
Design
A rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers.
Participants
Sixty-three medical students in their fourth or fifth year.
Interventions
Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.
Main Measures
Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).
Key Results
Participants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen’s
d
of 2.35 (95% confidence interval (CI) 1.62 to 3.01,
p
< 0.01) and of 1.83 (CI 1.13 to 2.47,
p
< 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (
d
between 0.91 and 2.04 (
p
< 0.001)).
Conclusions
Our results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge.
Trial Registration:
The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31823309</pmid><doi>10.1007/s11606-019-05420-w</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2020-02, Vol.35 (2), p.473-480 |
| issn | 0884-8734 1525-1497 |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Adult Clinical decision making Clinical trials Communication Confidence intervals Conflict of Interest Conflicts of interest Curricula Curriculum Decision making Decision Making, Shared Diagnostic systems Female Health care facilities Health risk assessment Humans Internal Medicine Intervention Male Medical students Medicine Medicine & Public Health Original Research Patients Pharmaceutical industry Physicians Randomization Risk communication Risk management Students, Medical Therapeutic applications Video communication |
| title | Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial |
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