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Development and evaluation of a further training program for Shared Decision Making in medical rehabilitation – PEFiT

Persons with chronic diseases are increasingly calling to be included in the decision-making process regarding their treatment. The content of this study is to develop and scientifically investigate a training program on shared decision making. Shared decision making means that patient and treatment provider decide on a treatment together. Therefore, both carry responsibility for this decision.

A second focus of the training is on shared decision-making in rehabilitation teams. In a rehabilitation team, different professional groups (physicians, nurses, psychologists, psychotherapists etc.) work together. In an ideal case scenario, their differing expertise should flow into the treatment planning. Once the team has agreed together on different treatment possibilities, these are discussed with the patient.

The training program is oriented to the managers of different professional groups in the rehab team. The managers should be trained in shared decision making between patient and treatment provider and within the rehab team. Within this study, it should be scientifically investigated whether training in shared decision making has positive effects, for example, on the satisfaction both of patients and of treatment providers. The study is oriented to patients with different diseases (e.g. back pain, depression, cardiovascular diseases).

 

Project leader:
Dr. Mirjam Körner

 

Project co-workers:

Dipl.-Psych. Anne-Kathrin Steger 
Dipl.-Päd. Heike Ehrhardt

 

Background

Involving patients with chronic diseases in an inter-professional treatment in medical rehabilitation requires the implementation of shared decision making (external participation) under consideration of the inter-professional teamwork (communication, cooperation, agreement, decision making etc.) in the rehabilitation team (internal participation).

 

Aims and research questions

The pilot study aims to develop an inter-professional train-the-trainer program for the implementation of shared decision-making in medical rehabilitation. The training was developed based on the desires and needs of the patients and the training requirements of the employees in terms of internal and external participation.

The aim of the main study was to then evaluate this inter-professional train-the-trainer program for shared decision making and to examine the influence of participation on the treatment acceptance and patient satisfaction.

 

Study design and methods

The pilot study has a cross-sectional design. The wishes and needs of the patients are measured in focus groups and the employees’ training requirements are captured through an expert survey. In a multi-centre, cluster-randomised controlled intervention study, the implementation of participation was evaluated with a patient survey (three measurement time points) and employee survey (two measurement time points).

 

Results

As the five most important needs of the patients, in four focus groups (n=36 patients), time, acknowledgement, participation, trust, and individuality were identified. The experts (treatment providers in management positions) expressed a particular need for training in terms of internal participation (teamwork), such as communicating with difficult team members, conducting critical conversations, moderating conflict dialogues, techniques for conducting dialogues and moderation of team processes etc. The results were applied in order to develop an inter-professional train-the-trainer program for shared decision making in medical rehabilitation. The training program comprised two 4-hour modules for the disseminators (treatment providers in management positions). For module 1, the German-language training program of Bieber et al. (2007) was adapted according to the wishes of the rehabilitees. It concentrates on the external participation in the treatment provider-patient relationship, whereas module 2 was newly developed and covers internal participation (i.e. information, communication, agreement, coordination and cooperation in the treatment team).

Both modules were implemented and evaluated in five clinics. The trained disseminators evaluated the training positively and trained their employees. The control group comprised six clinics. The employers of the trained clinics rated the implementation of shared decision making (external participation) after the training as significantly better than before the training. Internal participation rose in both the intervention group and the control group. For the patients, a weak positive trend was apparent with regard to the internal and external participation. The nurses benefited most clearly from the training. The internal participation (teamwork) and the satisfaction with the decision were shown to be the strongest predictors of treatment acceptance and patient satisfaction.

 

Summary and outlook

In the study, the first inter-professional training program on shared decision making was developed and evaluated. In this respect, besides shared decision making (external participation), internal participation was also considered. The results confirm that in order to set up shared decision making in inter-professional settings such as medical rehabilitation, it is important to take into account internal participation (in the team) in addition to external participation (in the treatment provider-patient interaction). Personnel development (training of treatment providers), team development of the treatment team and organisational development in the rehabilitation clinic should, in the future, be more strongly combined for purposes of strengthening shared decision making.

 

Publications that have resulted in the framework of this project (as of May 2012)

•  Körner, M. (2009). Ein Modell der partizipativen Entscheidungsfindung in der medizinischen Rehabilitation. Die Rehabilitation, 48, 160-165.

• Körner M., Ehrhardt, H. & Steger, A.-K. (2011). Patientenorientierung in der medizinischen Rehabilitation. Public Health Forum, 70, 21-23.
• Körner, M., Ehrhardt, H., Steger, A.-K. (2011). Entwicklung eines interprofessionellen Trai­nings zur Implementierung der partizipativen Entscheidungsfindung in Rehabilitations­kliniken. Die Rehabilitation, 50: 331-339.

• Körner, M., Ehrhardt, H., Steger, A.-K., Bengel, J. (in press). Interprofessional SDM Train-the-trainer program “Fit for SDM”:  Provider satisfaction and impact on participation . Patient Education and Counseling

 

Project results have been reported at the following congresses (selection):

• Körner, M., Steger A.-K., Ehrhardt, H. (2009). Interprofessionelles Trainingsprogramm zur partizipativen Entscheidungsfindung für Führungskräfte in der medizinischen Rehabili­ta­tion. DRV-Schriften, Band 83 (S. 63-64). Berlin: Deutsche Rentenver­sicherung Bund.
• Ehrhardt, H., Steger, A.-K., Körner, M. (2009) Delphi-Befragung zum Thema Interne Partizi­pative Entscheidungsfindung in der medizinischen Rehabilitation. DRV-Schriften, Band 83 (S. 73-75). Berlin: Deutsche Rentenver­sicherung Bund.
• Steger, A.-K., Ehrhardt, H., Körner, M. (2009) Bedürfnisse und Präferenzen von Patienten in der medizinischen Rehabilitation zu Partizipativer Ent­scheid­ungs­find­ung – eine qualita­tive Studie. DRV-Schriften, Band 83 (S. 78-79). Berlin: Deutsche Rentenver­sicherung Bund.
• Körner, M. (2009). Interprofessional Approach of Shared Decision-Making in Medical Reha­bilitation. 5th International Shared Decision Making Conference, Boston, USA, June14-17, 2009.
• Körner, M., Steger, A.-K., Ehrhardt, H. (2009). Development of an Interprofessional Training to Shared-Decision-Making 5th International Shared Decision Making Conference Boston, USA, June14-17, 2009.
• Steger, A.-K.; Ehrhardt, H., Körner, M. (2009). Improving Compliance Through Shared-Deci­sion Making – Preferences of Patients in Medical Rehabilitation. 5th International Shared Decision Making Conference, Boston, USA, June14-17, 2009.
• Ehrhardt, H., Steger, A.-K., Körner, M. (2009). Präferenzen und Trainingsbedarf von Füh­rungskräften in interdisziplinären Rehabilitationsteams [Abstract]. Korunka, Ch., Kirchler, E., Ulferts, H. (Hrsg.), Entscheidungen und Veränderungen in Arbeit, Organi­sation und Wirtschaft. 6. Tagung der Fachgruppe Arbeits- und Organisationspsycholo­gie der Deutschen Gesellschaft für Psychologie (S. 201). Wien: Fakultas
• Körner, M., Ehrhardt, H., Steger A.-K. (2009). Implementierung von partizipativer Kommuni­kation und Entscheidungsfindung in der medizinischen Rehabilitation. Solidaritäten im Wandel. Gemeinsame Tagung der Deutschen Gesellschaft für Sozialmedizin und Prä­vention und der Deutschen Gesellschaft für Medizinische Soziologie. Das Gesund­heitswesen, 8/9, 2009, 567-568.
• Ehrhardt H.,  Steger A.-K., Körner M. (2009). Kommunikation und Partizipative Entschei­dungsfindung im interprofessionellen Team der medizinischen Rehabilitation. Zeitschrift für Allgemeinmedizin, Sonderausgabe DEGAM/DKVF 2009, 31.
• Körner, M., Ehrhardt, H., Steger, A.-K., (2009). Developing a train-the-trainer program for providers in leading positions to implement the interaction style of shared decision-making in health care facilities. International Conference on Communication in Health­care, Miami, USA.
• Steger, A.-K.; Ehrhardt, H., Körner, M. (2009). Patients’ preferences for participation, com­munication and provider-patient-interaction in medical rehabilitation. International Con­ference on Communication in Healthcare, Miami, USA.
• Körner, M., Steger A.-K., Ehrhardt, H. (2010). Interne Patientenorientierung in der medizini­schen Rehabilitation aus Sicht der Behandler. DRV-Schriften, Band 88 (S.239-241). Berlin: Deutsche Rentenversicherung.
• Ehrhardt H., Steger A.-K., Körner M. (2010). Kooperation im Reha-Team: Führung, Partizi­pation und Betriebsklima. DRV-Schriften, Band 88 (S.237-238). Berlin: Deutsche Ren­tenversicherung.
• Steger, A.-K.; Ehrhardt, H., Körner, M. (2010). Partizipation an Behandlungsentscheidungen in der medizinischen Rehabilitation - Einschätzung von Patienten vs. Behandler. DRV-Schriften, Band 88 (S.558-559). Berlin: Deutsche Rentenversicherung.
• Körner, M., Steger A.-K., Ehrhardt, H. (2010). Patient-centered communication and partici­pation in medical rehabilitation [14G]. European Association for Communication in Healthcare. International Conference on Communication in Healthcare 2010, 7.-10, Ve­rona, Italy.
• Körner, M., Ehrhardt, H., Steger A.-K. (2010). Developing and evaluating interprofessional health care team training for shared decision-making [P2.5.15].  European Association for Communication in Healthcare. International Conference on Communication in Healthcare 2010, 7.-10, Verona, Italy.
• Ehrhardt H., Steger, A.-K., Körner, M. (2010). Implementierung und Evaluation einer inter­disziplinären Schulungsmaßnahme zur internen und externen Patientenorientierung. Zeitschrift für Medizinische Psychologie Sonderheft 2010, 19, (S. 15-16).
• Ehrhardt, H., Steger, A.-K., Körner, M. (2011). Das interprofessionelle Schulungsprogramm „Fit für PEF“ zur Förderung der Partizipation und Kooperation in Rehabilitationskliniken. DRV-Schriften, Band 93 (S. 150-152)
• Körner, M., Ehrhardt, H.; Steger, A.-K. (2011). Integrierte Patientenorientierung in der medi­zinischen Rehabilitation. 20. DRV-Schriften, Band 93 (S. 157-159)
• Steger, A.-K., Ehrhardt, H., Körner, M. (2011). Partizipation, Information und Patientenzu­friedenheit - Vergleiche zwischen somatischer und psychosomatischer Rehabilitation. DRV-Schriften, Band 93 (S. 143-144).
• Körner, M., Ehrhardt, H., Steger, A.-K. (2011). Shared decision-making in an interprofes­sional context. 6^th International Shared Decision Making Conference (p. 62). Maastricht University: School of Public Health and Primary Care.
• Körner, M., Ehrhardt, H., Steger, A.-K. (2011). Interprofessional training for shared decision-making in medical rehabilitation. 6^th International Shared Decision Making Conference, (p. 61). Maastricht University: School of Public Health and Primary Care.
• Zerpies, E., Steger, A.-K., Ehrhardt, H., Körner, M. (2011). Wirksamkeit eines Trainingsprogramms zur partizipativen Entscheidungsfindung in der psychosoma-tischen und der somatischen Rehabilitation. Das Gesundheitswesen, 73, DOI: 10.1055/s-0031-1283691.
• Körner M., Steger, A.-K., Ehrhardt, H., Zerpies E., Bengel J. (2012).  Evaluation des inter­professionellen Trainingsprogramms „Fit für PEF“  zur Implementierung der partizipati­ven Entscheidungsfindung  in der medizinischen Rehabilitation. DRV-Schriften, 98 (S. 141-142).
• Körner, M., Ehrhardt, H., Steger, A.-K., Zimmermann, L., Müller, C., Bengel, J. (2012). Ein­fluss eines interprofessionellen Trainings auf Kommunikation, Führung und Entschei­dungsfindung im Rehabilitationsteam. DRV-Schriften, 98 (S. 148-150).

 

Cooperating clinics

• AOK-Klinik Korbmattfelsenhof (Baden-Baden)
• AOK-Klinik Stöckenhöfe (Wittnau)
• AOK Klinik Schlossberg (Bad Liebenzell)
• Asklepios Triberg (Triberg)
• DAK-Haus Schwaben (Bad Mergentheim)
• Földi-Klinik (Hinterzarten)
• Kliniken Dr. Vötisch (Bad Mergentheim)
• Klinik Bad Herrenalb (Bad Herrenalb)
• Kurpark-Klinik (Überlingen a. Bodensee)
• Neurologisches Rehabilitationszentrum Quellenhof (Bad Wildbad)
• Rehabilitationsklinik Birkenbuck (Malsburg-Marzell)
• Rehaklinik-Glöcklehof (Schluchsee)
• Reha-Klinik Glotterbad (Glottertal)
• Rehaklinik St. Landelin (Herbolzheim)
• Reha-Zentrum Todtmoos (Todtmoos)
• Rheintalklinik (Bad-Krozingen)
• Rehabilitationsklinik Höhenblick (Baden-Baden)

• Therapiezentrum Münzesheim (Kraichtal-Münzesheim)

 

Links:

• Project information PEFiT
• Fit for SDM – Information on the training
• Project description homepage Department of Medical Sociology, Albert-Ludwig University of Freiburg

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