Study protocol of a randomized controlled trial on two new dissemination strategies for a brief, shared-decision-making (SDM) training for oncologists: web-based interactive SDM online-training versus individualized context-based SDM face-to-face training

Different studies have revealed that cancer patients do not feel sufficiently involved in important treatment decisions [1, 2]. Patients often feel that physicians decide in a too paternalistic way and do not consider the patient’s personal life situation, expectations, preferences and fears. Patients who experienced paternalism were less satisfied with the consultation and emotional support [3].

An attempt to overcome those shortcomings in patient-physician communication is the implementation of the model of shared decision-making (SDM) into routine care. SDM is seen as an ideal model for how physicians and patients should interact in medical decision-making [4]. In this concept, both the patient’s medical and personal information are shared between physician and patient, and both parties (in an equal position) subsequently come to a shared decision as a team. Implementation of SDM requires that the physician has a patient-centered attitude and is open to the needs of the patient.

A review by Chewning et al. [5] about role preferences in medical decision-making showed a trend to an increasing demand for SDM by patients in recent years. Studies indicate that if SDM is implemented, patients show a higher level of treatment satisfaction [6‐8], a higher level of risk comprehension, less decisional conflict [9], more realistic expectations towards the therapy [10], a higher level of treatment adherence and better coping with illness [11]. Furthermore, a higher quality of physician-patient interaction can be achieved [12].

Despite physicians’ positive attitude towards SDM [13], implementation in daily practice is insufficient (e.g., [14, 15]), as there are many barriers such as time constraints, patient characteristics and the nature of the clinical situation [16].

In recent years, there has been a growing number of SDM training programs for physicians [17] which teach them how to involve their patients in important treatment decisions [18, 19]. However, it remains unclear what kind of intervention is most effective to enhance physician competence at SDM [20].

Earlier studies have shown that it is difficult to enroll physicians for an SDM training intervention that occurs in an external setting. Especially, economic and psychological factors seem to represent the major barriers [18]. Moreover, physicians frequently overestimate their own communication skills [21], which consequently leads to an unwillingness to spend time participating in communication trainings.

Because of these circumstances, it has been suggested that new SDM training strategies might be necessary that can be administered independently of time and place: e.g., individualized, context-based, face-to-face SDM trainings or web-based online SDM trainings constitute possible alternatives for common SDM group-based trainings [18, 22] and could potentially address physicians’ temporal and locational constraints that have previously inhibited participation.

Context-based communication trainings for physicians have achieved good results in the improvement of physicians’ communication skills in clinical encounters [21, 23, 24]. Moreover, from the physicians’ point of view, face-to-face interventions have some advantages: They feel less undermined in their expert role, and their existent communication skills are recognized [21].

Web-based trainings are effective opportunities for physician education [25‐28]. The challenge in developing SDM online trainings consists in providing practical (procedural) and not merely factual (declarative) knowledge [25, 29, 30]. There is evidence that well-designed online tutorials facilitate the acquisition of complex skills as well as reduce time in the acquisition of these skills compared to traditional formats such as personal lectures (e.g., [31]). Well-designed online trainings show advantages regarding time efficacy and memory effects compared to traditional teaching methods such as frontal presentations [32, 33], which seem to be effective in improving knowledge but less effective in changing behavior [34, 35].

However, when compared to web-based trainings, face-to-face trainings generally seem to be more effective [26].

This study protocol was written in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The SPIRIT Checklist has been included in Additional file 1.

This trial will assess the effectiveness and acceptability of two innovative SDM training programs for physicians. We aim to analyze which improvements in SDM competence can be achieved by these training programs and their impact on the physician-patient interaction and to test if the dissemination methods differ regarding their efficacy.

Although we aim to meet the needs of the physicians in their daily routine, we anticipate some challenges in recruitment for the study. As the training is voluntary, it cannot be assumed that it can be performed during working hours. If the participants must complete the training in their leisure time, this could likely influence their motivation and, therefore, the expected effects of the training. Furthermore, face-to-face SDM training will be conducted by different members of the project team. Although we intend to standardize the coaching sessions, as far as possible, it cannot be avoided that there will be some differences between training lessons performed by different trainers. Although we train the SPs in oncological case vignettes to enable them to act in a standardized way, every SP brings his own personality and attitudes to the consultations. Furthermore, it is inevitable that the SPs will undergo an increase in medical knowledge as the study evolves and, therefore, may show a behavior change during later consultations. We will try to compensate for this by strictly monitoring consultations, and we will give additional training lessons if needed. We expect in IG I with face-to-face training to gain a higher level of satisfaction. However, for long-term implementation of the training, we assume that regarding the temporal expense an online tutorial is more feasible in daily routine compared to face-to-face coaching lessons. Despite these challenges, we also see several opportunities. Specifically, we consider our web-based training as an adequate and cost-effective way to convey SDM-related knowledge and competences. If this hypothesis is validated, then our training indicates that this training format should be extended to other medical areas. Furthermore, we consider our training to be an appropriate way to convey other communication-related challenges (e.g., breaking bad news) in daily medical practice.

Physician recruitment for the trial started in the fall of 2016 and will last until December 2018.