A blended learning for general practitioners and nurses on skills to support shared decision-making with patients about palliative cancer treatment: A one-group pre-posttest study

Prospectively investigating the impact of AI onshared decision-making in post kidney transplant care (PRIMA-AI): protocol for a longitudinal qualitative study among patients, their support persons and treating physicians at a tertiary care centre

INTRODUCTION

As healthcare is shifting from a paternalistic to a patient-centred approach, medical decision making becomes more collaborative involving patients, their support persons (SPs) and physicians. Implementing shared decision-making (SDM) into clinical practice can be challenging and becomes even more complex with the introduction of artificial intelligence (AI) as a potential actant in the communicative network. Although there is more empirical research on patients' and physicians' perceptions of AI, little is known about the impact of AI on SDM. This study will help to fill this gap. To the best of our knowledge, this is the first systematic empirical investigation to prospectively assess the views of patients, their SPs and physicians on how AI affects SDM in physician-patient communication after kidney transplantation. Using a transdisciplinary approach, this study will explore the role and impact of an AI-decision support system (DSS) designed to assist with medical decision making in the clinical encounter.

METHODS AND ANALYSIS

This is a plan to roll out a 2 year, longitudinal qualitative interview study in a German kidney transplant centre. Semi-structured interviews with patients, SPs and physicians will be conducted at baseline and in 3-, 6-, 12- and 24-month follow-up. A total of 50 patient-SP dyads and their treating physicians will be recruited at baseline. Assuming a dropout rate of 20% per year, it is anticipated that 30 patient-SP dyads will be included in the last follow-up with the aim of achieving data saturation. Interviews will be audio-recorded and transcribed verbatim. Transcripts will be analysed using framework analysis. Participants will be asked to report on their (a) communication experiences and preferences, (b) views on the influence of the AI-based DSS on the normative foundations of the use of AI in medical decision-making, focusing on agency along with trustworthiness, transparency and responsibility and (c) perceptions of the use of the AI-based DSS, as well as barriers and facilitators to its implementation into routine care.

ETHICS AND DISSEMINATION

Approval has been granted by the local ethics committee of Charité-Universitätsmedizin Berlin (EA1/177/23 on 08 August 2023). This research will be conducted in accordance with the principles of the Declaration of Helsinki (1996). The study findings will be used to develop communication guidance for physicians on how to introduce and sustainably implement AI-assisted SDM. The study results will also be used to develop lay language patient information on AI-assisted SDM. A broad dissemination strategy will help communicate the results of this research to a variety of target groups, including scientific and non-scientific audiences, to allow for a more informed discourse among different actors from policy, science and society on the role and impact of AI in physician-patient communication.

Through the Eyes of Patients: The Effect of Training General Practitioners and Nurses on Perceived Shared Decision-Making Support

PURPOSE

To examine the effects of training general practitioners and nurses in shared decision-making (SDM) support as perceived by cancer patients and survivors.

DESIGN

An innovative, experimental design was adopted that included analogue patients (APs), that is, people who have or have had cancer and who imagine themselves in the position of the actor-patient presented in a video. Each AP assessed a video-recorded simulated consultation of a health care professional (HCP) conducted before or after an SDM support training program. The primary outcome was the APs' perceived SDM support with 13 self-developed items reflecting the perceived patient benefit of SDM support as well as the perceived HCP support behavior. Secondary outcomes included an overall rating of SDM support, AP-reported extent of SDM (CollaboRATE), satisfaction with the communication (Patient Satisfaction Questionnaire), conversation appreciation and helpfulness, as well as decision-making satisfaction and confidence (visual analog scale, 0-100). In addition, patient and HCP characteristics associated with AP-perceived SDM support were examined.

RESULTS

APs (n = 131) did not significantly differentiate trained from untrained HCPs in their perceptions of SDM support nor in secondary outcomes. Agreement between APs' perceptions was poor. The higher the perceived comparability of the consultation with APs' previous personal experiences, the higher their rating of SDM support.

LIMITATIONS

We used a nonvalidated primary outcome and an innovative study design that should be tested in future work.

CONCLUSIONS

Despite the limitations of the study design, the training seemed to not affect cancer patients' and survivors' perceived SDM support.

IMPLICATIONS

The clinical relevance of the training on SDM support needs to be established. The variation in APs' assessments suggests patients differ in their perception of SDM support, stressing the importance of patient-tailored SDM support.

HIGHLIGHTS

Cancer patients and survivors did not significantly differentiate trained from untrained HCPs when evaluating SDM support, and agreement between their perceptions was poor.The clinical relevance of training GPs and nurses in SDM support needs to be established.Patient-tailored SDM support may be recommended, given the variation in APs' assessments and their possible diverging perceptions of SDM support.This innovative study design (having patients watch and assess videos of simulated consultations made in the context of training evaluation) needs to be further developed.

Asynchronous e-learning with technology-enabled and enhanced training for continuing education of nurses: a scoping review

BACKGROUND

Asynchronous e-learning has become the mainstream choice since the transformation of learning formats by the coronavirus disease-19 pandemic. This scoping review aimed to examine the technologies used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness.

METHODS

This scoping review covered the period between 2011 and 2023. Six databases were searched for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol.

RESULTS

Sixty articles met the inclusion criteria. There was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options after 2017. The enabling technological approaches, such as interactive online modules (25 articles) and video modules (25 articles), are described in the articles. The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles).

CONCLUSIONS

Notably, many interactive TEET modules were used in asynchronous e-learning. There were few studies on gamification, computer simulation or virtual reality, and scenario-based learning (techniques to enhance intrinsic motivation further). However, the adoption of asynchronous e-learning with advanced TEET options is anticipated to increase in the future. Therefore, objective outcome measures are required to determine the effects of such learning methods on knowledge acquisition and behavioral changes.