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Scheibler F, Geiger F, Wehkamp K, Danner M, Debrouwere M, Stolz-Klingenberg C, Schuldt-Joswig A, Sommer CG, Kopeleva O, Bünzen C, Wagner-Ullrich C, Koch G, Coors M, Wehking F, Clayman M, Weymayr C, Sundmacher L, Rüffer JU. Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial. BMJ Evid Based Med 2024; 29:87-95. [PMID: 37890982 PMCID: PMC10982630 DOI: 10.1136/bmjebm-2023-112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM). DESIGN Pre-post study. SETTING University Hospital Schleswig-Holstein (UKSH), Kiel Campus. PARTICIPANTS Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH. INTERVENTIONS The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate. MAIN OUTCOME MEASURES In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre-post comparisons were done using t-tests. RESULTS The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDM showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects. CONCLUSIONS The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
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Affiliation(s)
- Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
| | - Friedemann Geiger
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marion Danner
- DARUM Marion Danner und Anne Rummer GbR, Cologne, Germany
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Constanze Stolz-Klingenberg
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Anja Schuldt-Joswig
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christina Gesine Sommer
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Olga Kopeleva
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
- Department of General Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Claudia Bünzen
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christine Wagner-Ullrich
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Gerhard Koch
- Department for Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
| | - Marie Coors
- Department of Health Economics, Technical University of Munich, München, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Marla Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christian Weymayr
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, München, Germany
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Sommer GM, Broschewitz J, Huppert S, Sommer CG, Jahn N, Jansen-Winkeln B, Gockel I, Hau HM. The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: Visual spatial ability as a predictor for improved surgical performance: a randomized trial. Medicine (Baltimore) 2021; 100:e27844. [PMID: 34918632 PMCID: PMC8677906 DOI: 10.1097/md.0000000000027844] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 10/25/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Due to the current COVID-19 pandemic, surgical training has become increasingly challenging due to required social distancing. Therefore, the use of virtual reality (VR)-simulation could be a helpful tool for imparting surgical skills, especially in minimally invasive environments. Visual spatial ability (VSA) might influence the learning curve for laparoscopic surgical skills. However, little is known about the influence of VSA for surgical novices on VR-simulator training regarding the complexity of different tasks over a long-term training period. Our study evaluated prior VSA and VSA development in surgical trainees during VR-simulator training, and its influence on surgical performance in simulator training. METHODS In our single-center prospective two-arm randomized trial, VSA was measured with a tube figure test before curriculum training. After 1:1 randomization, the training group (TG) participated in the entire curriculum training consisting of 48 different VR-simulator tasks with varying difficulty over a continuous nine-day training session. The control group (CG) performed two of these tasks on day 1 and 9. Correlation and regression analyses were used to assess the influence of VSA on VR-related surgical skills and to measure procedural abilities. RESULTS Sixty students (33 women) were included. Significant improvements in the TG in surgical performance and faster completion times were observed from days 1 to 9 for the scope orientation 30° right-handed (SOR), and cholecystectomy dissection tasks after the structured 9-day training program. After training, the TG with pre-existing low VSA scores achieved performance levels similar to those with pre-existing high VSA scores for the two VR simulator tasks. Significant correlations between VSA and surgical performance on complex laparoscopic camera navigation SOR tasks were found before training. CONCLUSIONS Our study revealed that that all trainees improved their surgical skills irrespective of previous VSA during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more distinct in complex simulator tasks. Further, we demonstrated a positive relationship between VSA and surgical performance of the TG, especially at the beginning of training. Our results identified pre-existing levels of VSA as a predictor of surgical performance.
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Affiliation(s)
- Guillermo Marcos Sommer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Johannes Broschewitz
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Sabine Huppert
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Christina Gesine Sommer
- Department of National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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