Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach
Abstract
:1. Introduction
2. Materials and Methods
- Step 1:
- Define the critical decision problems for performing SDM tasks.
- Step 2:
- Identify the driving aspects/criteria for developing SDM execution capability through a review of the literature and expert interviews.
- Step 3:
- Investigate the level of importance and awareness of each aspect/criterion and evaluate the state of importance and awareness using the IAA method.
- Step 4:
- Construct the cause–effect influence relation structure for SDM competency development via the NRM analysis.
- Step 5:
- Integrating the IIA and NRM. The IIA defines aspects that are important and unaware of SDM competency. Meanwhile, the NRM traces the key aspects that handle SDM development. Then, establish the adopted strategy by merging the findings of the IAA and NRM approach.
- Step 6:
- Combine the adoption paths of the importance indicator and awareness indicator via the rank of aspects and determine the suited adoption paths.
- Step 7:
- Identify common adoption paths using ranking the aspects for different physician stakeholders.
- Step 8:
- Select the paths that have both suited adoption paths and common adoption paths as common suited adoption paths through the IAA-NRM method.
2.1. Establish the Content of the SDM Competencies
2.1.1. Perception Assessment and Practice (PP)
2.1.2. Execution Process and Skills (ES)
2.1.3. Physician–Patient Relationship and Interaction (RI)
2.1.4. Shared Information and Decision Making (SD)
Aspects/Criteria | Item Descriptions | References |
---|---|---|
Perception assessment and practice (PP) | ||
SDM concept and connotation (PP1) | Physicians can effectively understand the definition and connotation of SDM. | [1,35,36] |
SDM values and identity (PP2) | Physicians can effectively understand the importance of SDM and agree with the value of SDM. | [8,34] |
SDM perception and assessment (PP3) | Physicians can guide patients to make SDM from patients’ representations and contexts. | [12,33] |
Knowledge of evidence-based medicine (PP4) | Emerging medical information and evidence-based medicine can help improve physicians’ ability to accomplish SDM. | [1,37] |
Execution process and skills (ES) | ||
Understand decision process and steps (ES1) | Physicians can have the expertise required to implement SDM in medical consultation. | [1,24,25] |
Skills for evidence-based medicine (ES2) | Physicians have skills for evidence-based medicine to assist the SDM process. | [36,37] |
Assistance of decision-making tools (ES3) | Physicians can use digital media materials and patient decision aids to oblige medical decision making and enhance communication. | [15,38] |
Patient engagement and guidance (ES4) | With respect for patient autonomy in decision making, physicians can advise patients to express personal opinions and encourage mutual participation promptly. | [34,39] |
Physician–patient relationship and interaction (RI) | ||
Doctor–patient relationship building (RI1) | To face patients with different characteristics and backgrounds, physicians can fully understand, endure, and effectively establish an excellent doctor–patient relationship. | [8,40,41] |
Verbal or nonverbal communication (RI2) | Physicians should communicate messages in a way that is easy for patients to comprehend and allow them to understand before expressing their wishes fully. | [8,42] |
Teaching back and execute (RI3) | Physicians should take appropriate response teaching and confirm that the patient can understand and accurately execute the content of the response teaching. | [43] |
Team coordination and cooperation (RI4) | Physicians should learn to work with medical teams and other healthcare staff to improve the quality and outcomes of patient care. | [44,45] |
Shared information and decision making (SD) | ||
Decision needs’ assessment (SD1) | Physicians should understand patients’ value and preferences and apply evidence-based medical information to guide patients on diverse treatment options. | [1,46,50] |
Information sharing (SD2) | Physicians should share medical information with patients, explain the benefits and risks of different medical treatments, and further clarify their concerns and doubts, so patients can select the most appropriate therapy from various options. | [47,48,50] |
Co-participation decision making (SD3) | Physicians can allow patients and their families to participate in decision making. While patients fully understand the treatment plan with proper doctor–patient contact, doctors make final determinations with patients and document the reasons and content of the decision. | [37,49] |
Decision tracking and evaluation (SD4) | Physicians can follow up after the medical decision making and evaluate the treatment effect and patient satisfaction with the decision making. | [12,49] |
2.2. Questionnaire Design and Reliability Analysis
2.3. The IAA Approach
2.4. The DEMATEL Approach
- (1).
- Estimate the original average matrix
- (2).
- Compute the direct influence matrix
- (3).
- Compute indirect influence matrix
- (4).
- Calculate the full influence matrix
- (5).
- Examine the NRM (network relation map)
2.5. The IAA-NRM Approach
3. Results
3.1. Reliability Analysis
3.2. The IAA-NRM Approach
3.3. Evaluation of the Suited Adoption Paths via the Rank of Aspects
3.4. Determination of Common Adoption Paths Using the Aspects Rank for Different Stakeholders
3.5. Explore the Available Paths and Suitable Adoption Paths for Various Levels of Physicians to Perform SDM Tasks
3.5.1. The Suited Adoption Paths for Attending Physicians
3.5.2. The Suited Adoption Paths for Medical Residents
3.5.3. The Suited Adoption Paths for PGYs
3.6. Explore Common Adoption Paths for Various Levels of Physicians to Perform SDM Tasks
3.6.1. Common Adoption Paths for II (Importance Indicator)
3.6.2. Common Adoption Paths for AI (Awareness Indicator)
4. Discussion
4.1. Comparison of Suitable Adoption Paths among Different Physician Stakeholders
4.2. Comparison of Common Adoption Paths among Different Physician Stakeholders
4.2.1. Common Adoption Path of II (Importance Indicator)
4.2.2. Common Adoption Path of AI (Awareness Indicator)
4.3. Identify Common Suitable Adoption Paths among Different Physician Stakeholders
4.4. Review of Research Findings
- (1)
- Similarities in the IAA findings for all physicians: As shown in Table 4, in the II (importance indicator), the RI aspect is more crucial than the SD aspect, and the SD aspect is also more critical than the PP and ES aspects. Furthermore, the SD aspect is more awakened than the RI aspect, and the RI aspect is also more awakened than the ES and PP aspects in the AI (awareness indicator). Thus, hospital administrators and directors of medical education should learn that physicians focus more on SD and RI aspects (interactive process) than the PP and ES aspects (basic knowledge and skills) in the daily practice of SDM. However, the NRM approach revealed that the SD and RI aspects are influenced. So, hospital administrators and directors of medical education should keep sharing information, deepen decision making, and build effective physician–patient communication.
- (2)
- Differences in adoption strategies among different physician stakeholders: The PP and ES aspects are in the third quadrant (low importance and low awareness) for full sample. The PP and ES aspects are also in the third quadrant for medical residents and PGYs. However, the PP aspect shifts to the fourth quadrant (high importance and low awareness) for attending physicians. The SD and RI aspects are in the first quadrant (high importance and high awareness) for the full sample. The SD and RI aspects are also in the first quadrant (high importance and high awareness) for medical residents and PGYs. However, the SD aspect shifts to the second quadrant (low importance and high awareness) for attending physicians. Although all physicians (full sample) ignored the PP aspect, the PP aspect stands as the leading influencer in NRM analysis. As the goal of strategy C is to focus on strengthening abilities, we should discover paths to improve SDM perception and assessment, such as by the intervention of SDM training curriculum or standardized patients. For the residency or PGY training programs, SDM perception and assessment could be enhanced in the Objective Structured Clinical Examination (OSCE), Entrustable Professional Activity (EPA) evaluation, or simulation learning.
- (3)
- Focus on the key aspects driving SDM competency development: Our study observed that the PP aspect is the primary influencer of SDM competence development for all physician stakeholders by NRM analysis. Knowledge translation is defined as various stakeholders such as clinicians, patients, managers, and policy makers using knowledge in practice and decision making [71]. Knowledge and awareness among healthcare providers and patients, as well as decision aids and skills’ training, are needed for SDM to be more widely executed [49]. In a clinician’s opinion, common barriers to implementing SDM in clinical practice include lack of knowledge and familiarity with SDM, poor interpersonal skills, and time pressure [3,72]. Knowledge of SDM can increase healthcare professionals’ positive attitude and willingness to practice SDM [71]. The initiation of an SDM program requires consideration of the health provider’s knowledge and beliefs regarding SDM [4]. A previous study in Taiwan found that adequate knowledge of SDM among medical staff is one of the three most common major facilitators [30]. A recent systematic review found that there is a controversial effect to improving SDM knowledge and skills through the training programs targeting medical doctors [3]. A study for junior doctors in Denmark demonstrated that most of the survey respondents were satisfied with their SDM learning outcomes from the training course: knowledge (73%), competencies (57%), and communication skills (66%) [73]. The current study disclosed that physicians’ SDM perceptions of the background and rationale of SDM is the critical driving factor to promote SDM development. The IAA-NRM approach helps clinicians address the gaps of needs, find the best path, and inform the SDM development strategies. Therefore, this study suggests that the effective implementation of SDM perception can deepen decision making and facilitate the physician–patient relationship.
- (4)
- The SDM competency development for attending physicians: Attending physicians are required to address a wide range of issues, and they must master both clinical and many non-clinical tasks [74]. Moreover, as the initiators of medical decision making in clinical practice, the attending physicians should be familiar with and be able to participate in the SDM process. They appear to play an essential role in encouraging patient engagement and offering options [75]. SDM is an application that requires mapping competencies to specific clinical tasks in medical disciplines and considering medical needs and patient values and preferences. The SD aspect is in the second quadrant (attention strategy), the ES aspect is in the third quadrant (focus strategy), and the PP aspect is in the fourth quadrant (monitoring strategy) for attending physicians’ points of view. It seems that the attending physicians are familiar with the steps of SDM and have integrated the SDM process into daily practice. Although they are not alert to SDM perception and neglect the practice skills, they believe that perception of SDM is essential, and we can strengthen the perception of SDM, leading to positive attitudes toward and improving the practice and skill of SDM.
- (5)
- The SDM competency development for medical residents: During residency training, medical residents follow the instructions of the supervising (attending) physician. Although they learn to discuss patient problems with team members, their role in decision making is more passive [74]. A qualitative study showed that interns know different content and learn differently at rounds with or without an attending physician. Interns learned SDM with families from observing attending physicians’ communication and had not seen medical residents do it [76]. While residency training programs assess how medical residents acquire implementation of SDM [77], there is little research on how a resident’s contextual factors or the attending physician’s opinion can influence a resident’s opportunity to practice these skills. In exploring barriers to medical residents learning SDM implementation, studies have identified a lack of familiarity with SDM concepts, lack of feedback on communication skills, and lack of formal training education [78,79]. Our study observed that medical residents feel the importance and are aware of SD and RI aspects rather than the PP and ES aspects by IAA analysis. We should focus on improving the PP and ES aspects and keeping the SD and RI aspects for medical residents.
- (6)
- The SDM competency development for PGYs: The medical education system in Taiwan has been reformed in recent years: 6 years of medical school after senior high school graduation, including two years of clinical clerkship at hospitals. After passing the national examination for physicians, doctors have two years of post-graduate training, followed by the residency training in various specialties [80]. Several studies have documented insufficient training for SDM and patient-centered communication during graduate medical education [47,81]. The PGY training programs are non-specific and focus on the general medical training to improve the ability of patient-centered care. They belong to external stakeholders as compared to specialty-specific medical residents in the medical team. Their experiences of SDM implementation are sparse. Based on the NRM analysis of our study, the SDM concept and practice should be rooted and promoted in junior doctors, especially in implementing the aspect of perception.
- (7)
- Design talent cultivation programs for SDM competency development: The practice of SDM impacts patients, physicians, and hospitals alike. How can we better cultivate medical residents or PGYs to obtain ideal SDM implementation during their training and beyond? Several measures would improve physicians’ professionalism on SDM in preparing young doctors for this critical task; for example, clarifying SDM as a core clinical practice that needs planned teaching, confirming that attending physicians are adequately competent in fundamental elements of SDM, evaluating and providing feedback through direct observation, using OSCE or EPA exams to measure learning outcomes. It is critical that attending physicians themselves demonstrate contemporary understanding and competence for SDM through continuing medical education, grand rounds, on-the-job training, and other forms of continuing professional development.
- (8)
- Tailored sustainable training plans for different physician stakeholders: This study determined that the stakeholders should include senior physicians (attending physicians and medical residents) and junior physicians (PGYs), even though there are no common adoption paths based on all physicians as illustrated in Table 14. Therefore, there are three common adoption paths (PP→SD→RI; PP→ES→RI; PP→ES→SD→RI) based on the senior physicians (attending physicians and medical residents). The second suited adoption path is that the PP aspect improves the SD aspect and the SD aspect improves the RI aspect. The third suited adoption path is that the PP aspect influences the ES aspect and the ES aspect affects the RI aspect. The fourth suited adoption path is that the PP aspect affects the ES aspect, the ES aspect improves the SD aspect, and then the SD aspect improves the RI aspect, as shown in Table 14. The senior physicians hold the core role of SDM promotion in clinical practice and senior physicians have more opportunities to practice and use SDM. For both attending physicians and medical residents, more training for SDM is likely warranted. Based on our findings, the improvement of SDM perception and evaluation for senior physicians can enhance skills and practice of SDM, help clinicians engage in SDM, and initiate SDM conversations. Doctor–patient interactions can be more harmonious and appropriate decisions can be made together.
- (9)
- Comparing our results with those of other studies: In previous research on SDM training programs and surveys on physicians’ understanding of SDM, most only describe the training duration, training instruments, course assessment, teaching methods, content, trainees’ reflection, benefit or abilities obtained from SDM training, and facilitators or barriers for SDM promotion [3,4,47,49,73,74,78]. There is little evidence to suggest which SDM core competency training programs are most effective and which physicians’ SDM capabilities are priorities to require. This study uses the IAA-NRM process to investigate the critical aspects of SDM competency and the various aspects’ interactions and to create suitable development strategies.
5. Conclusions and Recommendations
5.1. Conclusions
5.2. Academic Contributions
5.3. Study Limitations
5.4. Future Studies
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
- Godolphin, W. Shared decision-making. Healthc. Q 2009, 12, e186–e190. [Google Scholar] [CrossRef] [PubMed]
- Charles, C.; Gafni, A.; Whelan, T. Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Soc. Sci. Med. 1997, 44, 681–692. [Google Scholar] [CrossRef]
- Ospina, N.S.; Toloza, F.J.; Barrera, F.; Bylund, C.L.; Erwin, P.J.; Montori, V. Educational programs to teach shared decision making to medical trainees: A systematic review. Patient Educ. Couns. 2020, 103, 1082–1094. [Google Scholar] [CrossRef]
- Bowen, D.J.; Nguyen, A.M.; LeRouge, C.; LePoire, E.; Sheng Kwan-Gett, T. Factors Affecting the Initiation of a Shared Decision Making Program in Obstetric Practices. Healthcare 2021, 9, 1217. [Google Scholar] [CrossRef] [PubMed]
- Yu, X.; Nakayama, M.; Wu, M.S.; Kim, Y.L.; Mushahar, L.; Szeto, C.C.; Schatell, D.; Finkelstein, F.O.; Quinn, R.R.; Duddington, M. Shared Decision-Making for a Dialysis Modality. Kidney Int. Rep. 2022, 7, 15–27. [Google Scholar] [CrossRef] [PubMed]
- Chen, K.-L.; Hsu, Y.-C.; Li, Y.-H.; Guo, F.-R.; Tsai, J.-S.; Cheng, S.-Y.; Huang, H.-L. Shared Decision-Making Model for Adolescent Smoking Cessation: Pilot Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 10970. [Google Scholar] [CrossRef]
- Kalsi, D.; Ward, J.; Lee, R.; Wee, B.; Fulford, K.W.; Handa, A. Recognizing the Dying Patient, When Less Could be More: A Diagnostic Framework for Shared Decision-Making at the End of Life. J. Patient Exp. 2020, 7, 621–628. [Google Scholar] [CrossRef] [PubMed]
- Morelli, E.; Mulas, O.; Caocci, G. Patient-Physician Communication in Acute Myeloid Leukemia and Myelodysplastic Syndrome. Clin. Pract. Epidemiol. Ment. Health CP EMH 2021, 17, 264. [Google Scholar] [CrossRef] [PubMed]
- Tanaka, Y.; Yamaguchi, A.; Miyamoto, T.; Tanimura, K.; Iwai, H.; Kaneko, Y.; Takeuchi, T.; Amano, K.; Iwamoto, N.; Kawakami, A.; et al. Selection of treatment regimens based on shared decision-making in patients with rheumatoid arthritis on remission in the FREE-J study. Rheumatology 2022. [Google Scholar] [CrossRef] [PubMed]
- Saeed, S.; Skaar, E.; Romarheim, A.; Chambers, J.B.; Bleie, Ø. Shared Decision-Making and Patient-Reported Outcome Measures in Valvular Heart Disease. Front. Cardiovasc. Med. 2022, 9, 863040. [Google Scholar] [CrossRef] [PubMed]
- Li, X.; Meng, M. Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review. Patient Prefer. Adherence 2021, 15, 2763–2781. [Google Scholar] [CrossRef] [PubMed]
- Liu, W.-Y.; Tung, T.-H.; Chuang, Y.-C.; Chien, C.-W. Using DEMATEL Technique to Identify the Key Success Factors of Shared Decision-Making Based on Influential Network Relationship Perspective. J. Healthc. Eng. 2021, 2021, 6618818. [Google Scholar] [CrossRef]
- Lauck, S.B.; Lewis, K.B.; Borregaard, B.; de Sousa, I. “What Is the Right Decision for Me?” Integrating Patient Perspectives Through Shared Decision-Making for Valvular Heart Disease Therapy. Can. J. Cardiol. 2021, 37, 1054–1063. [Google Scholar] [CrossRef] [PubMed]
- Lam, W.W.; Kwok, M.; Chan, M.; Hung, W.K.; Ying, M.; Or, A.; Kwong, A.; Suen, D.; Yoon, S.; Fielding, R. Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? Patient Educ. Couns. 2014, 94, 243–249. [Google Scholar] [CrossRef]
- Stacey, D.; Légaré, F.; Lewis, K.; Barry, M.J.; Bennett, C.L.; Eden, K.B.; Holmes-Rovner, M.; Llewellyn-Thomas, H.; Lyddiatt, A.; Thomson, R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev. 2017, 4, CD001431. [Google Scholar] [CrossRef]
- Barton, J.L.; Kunneman, M.; Hargraves, I.; LeBlanc, A.; Brito, J.P.; Scholl, I.; Montori, V.M. Envisioning shared decision making: A reflection for the next decade. MDM Policy Pract. 2020, 5, 2381468320963781. [Google Scholar] [CrossRef]
- Couët, N.; Desroches, S.; Robitaille, H.; Vaillancourt, H.; Leblanc, A.; Turcotte, S.; Elwyn, G.; Légaré, F. Assessments of the extent to which health-care providers involve patients in decision making: A systematic review of studies using the OPTION instrument. Health Expect. 2015, 18, 542–561. [Google Scholar] [CrossRef]
- Staveley, I.; Sullivan, P. We need more guidance on shared decision making. Br. J. Gen. Pract. 2015, 65, 663–664. [Google Scholar] [CrossRef]
- Joseph-Williams, N.; Lloyd, A.; Edwards, A.; Stobbart, L.; Tomson, D.; Macphail, S.; Dodd, C.; Brain, K.; Elwyn, G.; Thomson, R. Implementing shared decision making in the NHS: Lessons from the MAGIC programme. BMJ 2017, 357, j1744. [Google Scholar] [CrossRef]
- Légaré, F.; Adekpedjou, R.; Stacey, D.; Turcotte, S.; Kryworuchko, J.; Graham, I.D.; Lyddiatt, A.; Politi, M.C.; Thomson, R.; Elwyn, G. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst. Rev. 2018, 7, CD006732. [Google Scholar] [CrossRef]
- Schoonover, S.C.; Schoonover, H.; Nemerov, D.; Ehly, C. Competency-Based HR Applications: Results of a Comprehensive Survey; Reports of the Arthur Andersen, Schoonover; SHRM: Alexandria, VA, USA, 2000. [Google Scholar]
- Sinnott, G.; Madison, G.; Pataki, G. Competencies: Report of the Competencies Workgroup, Workforce and Succession Planning Work Groups; New York State Governor’s Office of Employee Relations and the Department of Civil Service: New York, NY, USA, 2002. [Google Scholar]
- Wu, W.-W.; Lee, Y.-T.; Tzeng, G.-H. Simplifying the manager competency model by using the rough set approach. In Proceedings of the International Workshop on Rough Sets, Fuzzy Sets, Data Mining, and Granular-Soft Computing, Regina, SK, Canada, 31 August—2 September 2005; pp. 484–494. [Google Scholar]
- Hargraves, I.G.; Fournier, A.K.; Montori, V.M.; Bierman, A.S. Generalized shared decision making approaches and patient problems. Adapting AHRQ’s SHARE Approach for Purposeful SDM. Patient Educ. Couns. 2020, 103, 2192–2199. [Google Scholar] [CrossRef]
- Elwyn, G.; Tsulukidze, M.; Edwards, A.; Légaré, F.; Newcombe, R. Using a ‘talk’model of shared decision making to propose an observation-based measure: Observer OPTION5 Item. Patient Educ. Couns. 2013, 93, 265–271. [Google Scholar] [CrossRef] [PubMed]
- Zua, B. Literacy: Gateway to a World of Exploits. Int. J. Educ. Lit. Stud. 2021, 9, 96–104. [Google Scholar] [CrossRef]
- Libert, Y.; Canivet, D.; Ménard, C.; Van Achte, L.; Farvacques, C.; Merckaert, I.; Liénard, A.; Klastersky, J.; Reynaert, C.; Slachmuylder, J.-L. Predictors of physicians’ communication performance in a decision-making encounter with a simulated advanced-stage cancer patient: A longitudinal study. Patient Educ. Couns. 2017, 100, 1672–1679. [Google Scholar] [CrossRef]
- Ritter, S.; Stirnemann, J.; Breckwoldt, J.; Stocker, H.; Fischler, M.; Mauler, S.; Fuhrer-Soulier, V.; Meier, C.A.; Nendaz, M. Shared decision-making training in internal medicine: A multisite intervention study. J. Grad. Med. Educ. 2019, 11, 146–151. [Google Scholar] [CrossRef]
- Gabus, A.; Fontela, E. World Problems, an Invitation to Further Thought within the Framework of DEMATEL; Battelle Geneva Research Centre: Switzerland, Geneva, 1972. [Google Scholar]
- Liao, H.-H.; Liang, H.-W.; Chen, H.-C.; Chang, C.-I.; Wang, P.-C.; Shih, C.-L. Shared decision making in Taiwan. Z. Für Evidenz Fortbild. Und Qual. Im Gesundh. 2017, 123, 95–98. [Google Scholar] [CrossRef]
- Huang, Y.K.; Chen, Y.T.; Chang, Y.C. The implementation of shared decision-making in clinical dentistry: Opportunity and change. J. Med. Assoc. 2022, 121, 1890–1891. [Google Scholar] [CrossRef]
- Lin, M.H.; Lin, S.C.; Lee, Y.H.; Wang, P.Y.; Wu, H.Y.; Hsu, H.C. The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan. PLoS ONE 2021, 16, e0257902. [Google Scholar] [CrossRef]
- Lee, Y.-C.; Wu, W.-L. Shared decision making and choice for bariatric surgery. Int. J. Environ. Res. Public Health 2019, 16, 4966. [Google Scholar] [CrossRef]
- Ernecoff, N.C.; Witteman, H.O.; Chon, K.; Chen, Y.; Buddadhumaruk, P.; Chiarchiaro, J.; Shotsberger, K.J.; Shields, A.M.; Myers, B.A.; Hough, C.L.; et al. Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs. J. Crit. Care 2016, 33, 19–25. [Google Scholar] [CrossRef]
- Légaré, F.; Ratté, S.; Gravel, K.; Graham, I.D. Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals' perceptions. Patient Educ Couns 2008, 73, 526–535. [Google Scholar] [CrossRef] [PubMed]
- Hoffmann, T.C.; Montori, V.M.; Del Mar, C. The connection between evidence-based medicine and shared decision making. Jama 2014, 312, 1295–1296. [Google Scholar] [CrossRef] [PubMed]
- Simons, M.; Rapport, F.; Zurynski, Y.; Stoodley, M.; Cullis, J.; Davidson, A.S. Links between evidence-based medicine and shared decision-making in courses for doctors in training: A scoping review. BMJ Open 2022, 12, e057335. [Google Scholar] [CrossRef]
- Khan, M.W.; Muehlschlegel, S. Shared Decision Making in Neurocritical Care. Neurosurg. Clin. N. Am. 2018, 29, 315–321. [Google Scholar] [CrossRef] [PubMed]
- Muscat, D.M.; Morony, S.; Trevena, L.; Hayen, A.; Shepherd, H.L.; Smith, S.K.; Dhillon, H.M.; Luxford, K.; Nutbeam, D.; McCaffery, K.J. Skills for shared decision-making: Evaluation of a health literacy program for consumers with lower literacy levels. HLRP: Health Lit. Res. Pract. 2019, 3, S58–S74. [Google Scholar] [CrossRef]
- Bieber, C.; Nicolai, J.; Hartmann, M.; Blumenstiel, K.; Ringel, N.; Schneider, A.; Härter, M.; Eich, W.; Loh, A. Training physicians in shared decision-making—Who can be reached and what is achieved? Patient Educ. Couns. 2009, 77, 48–54. [Google Scholar] [CrossRef]
- Hashim, M.J. Patient-centered communication: Basic skills. Am. Fam. Physician 2017, 95, 29–34. [Google Scholar]
- Iversen, E.D.; Wolderslund, M.; Kofoed, P.-E.; Gulbrandsen, P.; Poulsen, H.; Cold, S.; Ammentorp, J. Communication skills training: A means to promote time-efficient patient-centered communication in clinical practice. J. Patient-Cent. Res. Rev. 2021, 8, 307. [Google Scholar] [CrossRef]
- Seely, K.D.; Higgs, J.A. Utilizing the "teach-back" method to improve surgical informed consent and shared decision-making: A review. Patient Saf. Surg 2022, 16, 12. [Google Scholar] [CrossRef]
- Michalsen, A.; Long, A.C.; DeKeyser Ganz, F.; White, D.B.; Jensen, H.I.; Metaxa, V.; Hartog, C.S.; Latour, J.M.; Truog, R.D.; Kesecioglu, J.; et al. Interprofessional Shared Decision-Making in the ICU: A Systematic Review and Recommendations From an Expert Panel. Crit. Care Med. 2019, 47, 1258–1266. [Google Scholar] [CrossRef]
- Barbosa Detoni, K.; Lopes André, A.; Rezende, C.P.; Furtado, B.T.; de Araújo Medina Mendonça, S.; Ramalho-de-Oliveira, D. Interprofessional education for shared decision making in drug therapy: A scoping review. J Interprof Care 2022, 1–13. [Google Scholar] [CrossRef]
- Tidhar, M.; Benbassat, J. Teaching Shared Decision Making to Undergraduate Medical Students. Rambam Maimonides Med. J. 2021, 12, e0032. [Google Scholar] [CrossRef]
- Legare, F.; Witteman, H.O. Shared Decision Making: Examining Key Elements And Barriers To Adoption Into Routine Clinical Practice. Health Aff. 2013, 32, 276–284. [Google Scholar] [CrossRef]
- Charles, C.; Gafni, A.; Whelan, T. Decision-making in the physician–patient encounter: Revisiting the shared treatment decision-making model. Soc. Sci. Med. 1999, 49, 651–661. [Google Scholar] [CrossRef]
- Stiggelbout, A.M.; Pieterse, A.H.; De Haes, J.C. Shared decision making: Concepts, evidence, and practice. Patient Educ. Couns. 2015, 98, 1172–1179. [Google Scholar] [CrossRef]
- Kriston, L.; Scholl, I.; Hölzel, L.; Simon, D.; Loh, A.; Härter, M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 2010, 80, 94–99. [Google Scholar] [CrossRef] [PubMed]
- Martilla, J.A.; James, J.C. Importance-performance analysis. J. Mark. 1977, 41, 77–79. [Google Scholar] [CrossRef]
- Tonge, J.; Moore, S.A. Importance-satisfaction analysis for marine-park hinterlands: A Western Australian case study. Tour. Manag. 2007, 28, 768–776. [Google Scholar] [CrossRef]
- Wang, W.-C.; Lin, Y.-H.; Lin, C.-L.; Chung, C.-H.; Lee, M.-T. DEMATEL-based model to improve the performance in a matrix organization. Expert Syst. Appl. 2012, 39, 4978–4986. [Google Scholar] [CrossRef]
- Wang, W.-C.; Lin, C.-L.; Wang, S.-H.; Liu, J.-J.; Lee, M.-T. Application of importance-satisfaction analysis and influence-relations map to evaluate design delay factors. J. Civ. Eng. Manag. 2014, 20, 497–510. [Google Scholar] [CrossRef]
- Lin, C.-L. The analysis of sustainable development strategies for industrial tourism based on IOA-NRM approach. J. Clean. Prod. 2019, 241, 118281. [Google Scholar] [CrossRef]
- Hori, S.; Shimizu, Y. Designing methods of human interface for supervisory control systems. Control Eng. Pract. 1999, 7, 1413–1419. [Google Scholar] [CrossRef]
- Liou, J.J.; Yen, L.; Tzeng, G.-H. Building an effective safety management system for airlines. J. Air Transp. Manag. 2008, 14, 20–26. [Google Scholar] [CrossRef]
- Lin, C.-L.; Tzeng, G.-H. A value-created system of science (technology) park by using DEMATEL. Expert Syst. Appl. 2009, 36, 9683–9697. [Google Scholar] [CrossRef]
- Lin, C.-L. A novel hybrid decision-making model for determining product position under consideration of dependence and feedback. Appl. Math. Model. 2015, 39, 2194–2216. [Google Scholar] [CrossRef]
- Lin, C.-L.; Shih, Y.-H.; Tzeng, G.-H.; Yu, H.-C. A service selection model for digital music service platforms using a hybrid MCDM approach. Appl. Soft Comput. 2016, 48, 385–403. [Google Scholar] [CrossRef]
- Luthra, S.; Govindan, K.; Mangla, S.K. Structural model for sustainable consumption and production adoption—A grey-DEMATEL based approach. Resour. Conserv. Recycl. 2017, 125, 198–207. [Google Scholar] [CrossRef]
- Lin, C.-L.; Chang, K.-C. Establishing the service evaluation and selection system for emerging culture festival events using the hybrid MCDM technique. Curr. Issues Tour. 2020, 23, 2240–2272. [Google Scholar] [CrossRef]
- Fang, I.-C.; Chen, P.-T.; Chiu, H.-H.; Lin, C.-L.; Su, F.-C. Med-tech industry entry strategy analysis under COVID-19 impact. Healthcare 2020, 8, 431. [Google Scholar] [CrossRef]
- Chang, J.-J.; Lin, C.-L. Establishing Urban Revitalization and Regional Development Strategies with Consideration of Urban Stakeholders Based on the ISA-NRM Approach. Sustainability 2022, 14, 7230. [Google Scholar] [CrossRef]
- Mukai, M.; Ogasawara, K. Analysis of Factors Hindering the Dissemination of Medical Information Standards. Healthcare 2022, 10, 1248. [Google Scholar] [CrossRef]
- Chang, J.-J.; Chen, R.-F.; Lin, C.-L. Exploring the Driving Factors of Urban Music Festival Tourism and Service Development Strategies Using the Modified SIA-NRM Approach. Sustainability 2022, 14, 7498. [Google Scholar] [CrossRef]
- Zhang, L.; Liu, R.; Jiang, S.; Luo, G.; Liu, H.-C. Identification of key performance indicators for hospital management using an extended hesitant linguistic DEMATEL approach. Healthcare 2019, 8, 7. [Google Scholar] [CrossRef] [PubMed]
- Chuang, Y.-C.; Tung, T.-H.; Chen, J.-Y.; Chien, C.-W.; Shen, K.-Y. Exploration of the relationship among key risk factors of acute kidney injury for elderly patients considering COVID-19. Front. Med. 2021, 8, 639250. [Google Scholar] [CrossRef] [PubMed]
- Zhang, H.; Zhang, M.; Yan, W.; Liu, Y.; Jiang, Z.; Li, S. Analysis the drivers of environmental responsibility of Chinese auto manufacturing industry based on triple bottom line. Processes 2021, 9, 751. [Google Scholar] [CrossRef]
- Jin, Y.; Hong, H.; Liu, C.; Chien, C.-W.; Chuang, Y.-C.; Tung, T.-H. Exploring the Key Factors of Shared Decision-Making Through an Influential Network Relation Map: The Orthopedic Nurse's Perspective. Front. Med. 2021, 8, 762890. [Google Scholar] [CrossRef]
- Chung, M.C.; Juang, W.C.; Li, Y.C. Perceptions of shared decision making among health care professionals. J. Eval. Clin. Pract. 2019, 25, 1080–1087. [Google Scholar] [CrossRef]
- Pel-Littel, R.E.; Snaterse, M.; Teppich, N.M.; Buurman, B.M.; van Etten-Jamaludin, F.S.; van Weert, J.; Minkman, M.M.; Scholte op Reimer, W.J. Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: A systematic review. BMC Geriatr. 2021, 21, 112. [Google Scholar] [CrossRef]
- Jacobsen, M.H.; Sommer, C.; Wernberg, S.A.; Schultz, H.; Fage Hjortø, S.C.; Kristiansen, M. Evaluation of a national programme to improve shared decision-making skills among junior medical doctors in Denmark: A mixed methods study of satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. BMC Health Serv. Res. 2022, 22, 245. [Google Scholar] [CrossRef]
- Roten, C.; Baumgartner, C.; Mosimann, S.; Martin, Y.; Donzé, J.; Nohl, F.; Kraehenmann, S.; Monti, M.; Perrig, M.; Berendonk, C. Challenges in the transition from resident to attending physician in general internal medicine: A multicenter qualitative study. BMC Med. Educ. 2022, 22, 336. [Google Scholar] [CrossRef]
- Nota, I.; Drossaert, C.H.; Taal, E.; van de Laar, M.A. Arthritis patients' motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement. Clin. Rheumatol. 2016, 35, 1225–1235. [Google Scholar] [CrossRef] [Green Version]
- Seltz, L.B.; Preloger, E.; Hanson, J.L.; Lane, L. Ward rounds with or without an attending physician: How interns learn most successfully. Acad. Pediatrics 2016, 16, 638–644. [Google Scholar] [CrossRef]
- Silverman, H.; Lehmann, C.U.; Munger, B. Milestones: Critical elements in clinical informatics fellowship programs. Appl. Clin. Inform. 2016, 7, 177–190. [Google Scholar]
- Schoenfeld, E.M.; Goff, S.L.; Elia, T.R.; Khordipour, E.R.; Poronsky, K.E.; Nault, K.A.; Lindenauer, P.K.; Mazor, K.M. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education. J. Grad. Med. Educ. 2018, 10, 43–50. [Google Scholar] [CrossRef]
- Caldwell, J.G. Evaluating attitudes of first-year residents to shared decision making. Med. Educ. Online 2008, 13, 10. [Google Scholar] [CrossRef]
- Weng, T.-L.; Chu, F.-Y.; Li, C.-L.; Chen, T.-J. Choices of Specialties and Training Sites among Taiwanese Physicians Graduating from Polish Medical Schools. Int. J. Environ. Res. Public Health 2022, 19, 3727. [Google Scholar] [CrossRef]
- Henry, S.G.; Holmboe, E.S.; Frankel, R.M. Evidence-based competencies for improving communication skills in graduate medical education: A review with suggestions for implementation. Med. Teach. 2013, 35, 395–403. [Google Scholar] [CrossRef]
- Champagne-Langabeer, T.; Hedges, A.L. Physician gender as a source of implicit bias affecting clinical decision-making processes: A scoping review. BMC Med. Educ. 2021, 21, 171. [Google Scholar] [CrossRef]
- Nykänen, P.; Schön, U.-K.; Björk, A. Shared decision making in social services–some remaining questions. Nord. Soc. Work Res. 2021. [CrossRef]
Aspects/Criteria | Alpha | Result |
---|---|---|
Importance indicator | 0.969 | High |
Awareness indicator | 0.964 | High |
Aspects of evaluation system | 0.947 | High |
Aspects | IAA | NRM | AS | ||||
---|---|---|---|---|---|---|---|
II | AI | (II, AI) | d + r | d − r | (R, D) | ||
Perception assessment and practice (PP) | −0.565 | −0.854 | L, L | 66.534 | 0.589 | D (+,+) | C |
Execution process and skills (ES) | −1.092 | −0.805 | L, L | 68.384 | 0.574 | D (+,+) | C |
Physician–patient relationship and interaction (RI) | 1.067 | 0.478 | H, H | 68.413 | −0.811 | ID (+,−) | A |
Shared information and decision making (SD) | 0.590 | 1.181 | H, H | 67.526 | −0.352 | ID (+,−) | A |
II (Importance Indicator) | AI (Awareness Indicator) | |
---|---|---|
Rank | RI(1) > SD(2) > PP(3) > ES(4) | SD(1) > RI(2) > ES(3) > PP(4) |
Available paths | 1. PP(3)→RI(1) {N} 2. PP(3)→SD(2)→RI(1) {N} 3. PP(3)→ES(4)→RI(1) {Y} 4. PP(3)→ES(4)→SD(2)→RI(1) {Y} | 1. PP(4)→RI(2) {N} 2. PP(4)→SD(1)→RI(2) {Y} 3. PP(4)→ES(3)→RI(2) {N} 4. PP(4)→ES(3)→SD(1)→RI(2) {Y} |
Suited adoption paths | 4. PP→ES→SD→RI |
II (Importance Indicator) | AI (Awareness Indicator) | Suited Adoption Paths | |
---|---|---|---|
Attending physicians | |||
Rank | RI(1) > PP(2) > SD(3) > ES(4) | SD(1) > RI(2) > PP(3) = ES(3) | |
Available paths | 1. PP(2)→RI(1) {N} 2. PP(2)→SD(3)→RI(1) {Y} 3. PP(2)→ES(4)→RI(1) {Y} 4. PP(2)→ES(4)→SD(3)→RI(1) {Y} | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(3)→RI(2) {Y} 4. PP(3)→ES(3)→SD(1)→RI(2) {Y} | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Medical residents | |||
Rank | SD(1) > RI(2) > PP(3) > ES(4) | SD(1) > RI(2) > PP(3) > ES(4) | |
Available paths | 1. PP(3)→RI(1) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Common adoption paths | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI | Common suited adoption paths | |
2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Aspects | IAA | NRM | AS | ||||
---|---|---|---|---|---|---|---|
II | AI | (II, AI) | d + r | d − r | (R, D) | ||
Perception assessment and practice (PP) | 0.163 | −0.832 | H, L | 66.534 | 0.589 | D (+,+) | D |
Execution process and skills (ES) | −1.262 | −0.832 | L, L | 68.384 | 0.574 | D (+,+) | C |
Physician–patient relationship and interaction (RI) | 1.173 | 0.492 | H, H | 68.413 | −0.811 | ID (+,−) | A |
Shared information and decision making (SD) | −0.074 | 1.172 | L, H | 67.526 | −0.352 | ID (+,−) | B |
II (Importance Indicator) | AI (Awareness Indicator) | |
---|---|---|
Rank | RI(1) > PP(2) > SD(3) > ES(4) | SD(1) > RI(2) > PP(3) = ES(3) |
Available paths | 1. PP(2)→RI(1) {N} 2. PP(2)→SD(3)→RI(1) {Y} 3. PP(2)→ES(4)→RI(1) {Y} 4. PP(2)→ES(4)→SD(3)→RI(1) {Y} | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)= ES(3)→RI(2) {Y} 4. PP(3)= ES(3)→SD(1)→RI(2) {Y} |
Suited adoption paths | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Aspects | IAA | NRM | AS | ||||
---|---|---|---|---|---|---|---|
II | AI | (II, AI) | d + r | d − r | (R, D) | ||
Perception assessment and practice (PP) | −0.620 | −0.442 | L, L | 66.534 | 0.589 | D (+,+) | C |
Execution process and skills (ES) | −1.076 | −1.104 | L, L | 68.384 | 0.574 | D (+,+) | C |
Physician–patient relationship and interaction (RI) | 0.750 | 0.331 | H, H | 68.413 | −0.811 | ID (+,−) | A |
Shared information and decision making (SD) | 0.946 | 1.215 | H, H | 67.526 | −0.352 | ID (+,−) | A |
II (Importance Indicator) | AI (Awareness Indicator) | |
---|---|---|
Rank | SD(1) > RI(2) > PP(3) > ES(4) | SD(1) > RI(2) > PP(3) > ES(4) |
Available paths | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} |
Suited adoption paths | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Aspects | IAA | NRM | AS | ||||
---|---|---|---|---|---|---|---|
II | AI | (II, AI) | d + r | d − r | (R, D) | ||
Perception assessment and practice (PP) | −1.205 | −1.174 | L, L | 66.534 | 0.589 | D (+,+) | C |
Execution process and skills (ES) | −0.440 | −0.441 | L, L | 68.384 | 0.574 | D (+,+) | C |
Physician–patient relationship and interaction (RI) | 0.861 | 0.558 | H, H | 68.413 | −0.811 | ID (+,−) | A |
Shared information and decision making (SD) | 0.784 | 1.057 | H, H | 67.526 | −0.352 | ID (+,−) | A |
II (Importance Indicator) | AI (Awareness Indicator) | |
---|---|---|
Rank | RI(1) > SD(2) > ES(3) > PP(4) | SD(1) > RI(2) > ES(3) > PP(4) |
Available paths | 1. PP(4)→RI(1) {N} 2. PP(4)→SD(2)→RI(1) {N} 3. PP(4)→ES(3)→RI(1) {N} 4. PP(4)→ES(3)→SD(2)→RI(1) {N} | 1. PP(4)→RI(2) {N} 2. PP(4)→SD(1)→RI(2) {Y} 3. PP(4)→ES(3)→RI(2) {N} 4. PP(4)→ES(3)→SD(1)→RI(2) {Y} |
Suited adoption paths | - |
II (Importance Indicator) | |
---|---|
Attending physicians | |
Rank | RI(1) > PP(2) > SD(3) > ES(4) |
Available paths | 1. PP(2)→RI(1) {N} 2. PP(2)→SD(3)→RI(1) {Y} 3. PP(2)→ES(4)→RI(1) {Y} 4. PP(2)→ES(4)→SD(3)→RI(1) {Y} |
Medical residents | |
Rank | SD(1) > RI(2) > PP(3) > ES(4) |
Available paths | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} |
PGYs | |
Rank | RI(1) > SD(2) > ES(3) > PP(4) |
Available paths | 1. PP(4)→RI(1) {N} 2. PP(4)→SD(2)→RI(1) {N} 3. PP(4)→ES(3)→RI(1) {N} 4. PP(4)→ES(3)→SD(2)→RI(1) {N} |
Common adoption paths | - |
AI (Awareness Indicator) | |
---|---|
Attending physicians | |
Rank | SD(1) > RI(2) > PP(3) =ES(3) |
Available paths | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(3)→RI(2) {Y} 4. PP(3)→ES(3)→SD(1)→RI(2) {Y} |
Medical residents | |
Rank | SD(1) > RI(2) > PP(3) > ES(4) |
Available paths | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} |
PGYs | |
Rank | SD(1) > RI(2) > ES(3) > PP(4) |
Available paths | 1. PP(4)→RI(2) {N} 2. PP(4)→SD(1)→RI(2) {Y} 3. PP(4)→ES(3)→RI(2) {N} 4. PP(4)→ES(3)→SD(1)→RI(2) {Y} |
Common adoption paths | 2. PP(4)→SD(1)→RI(2) 4. PP(4)→ES(3)→SD(1)→RI(2) |
II (Importance Indicator) | AI (Awareness Indicator) | Suited Adoption Paths | |
---|---|---|---|
Senior physician -Attending physicians | |||
Rank | RI(1) > PP(2) > SD(3) > ES(4) | SD(1) > RI(2) > PP(3) = ES(3) | |
Available paths | 1. PP(2)→RI(1){N} 2. PP(2)→SD(3)→RI(1) {Y} 3. PP(2)→ES(4)→RI(1) {Y} 4. PP(2)→ES(4)→SD(3)→RI(1) {Y} | 1. PP(3)→RI(2){N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)= ES(3)→RI(2) {Y} 4. PP(3)= ES(3)→SD(1)→RI(2) {Y} | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Senior Physician -Medical residents | |||
Rank | SD(1) > RI(2) > PP(3) > ES(4) | SD(1) > RI(2) > PP(3) > ES(4) | |
Available paths | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) [Y] | 1. PP(3)→RI(2) {N} 2. PP(3)→SD(1)→RI(2) {Y} 3. PP(3)→ES(4)→RI(2) {Y} 4. PP(3)→ES(4)→SD(1)→RI(2) {Y} | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI |
Common adoption paths (attending physicians and medical residents) | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI | 2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI | Common suited adoption paths |
2. PP→SD→RI 3. PP→ES→RI 4. PP→ES→SD→RI | |||
Junior physician -PGYs | |||
Rank | RI(1) > SD(2) > ES(3) > PP(4) | SD(1) > RI(2) > ES(3) > PP(4) | |
Available paths | 1. PP(4)→RI(1) {N} 2. PP(4)→SD(2)→RI(1) {N} 3. PP(4)→ES(3)→RI(1) {N} 4. PP(4)→ES(3)→SD(2)→RI(1) {N} | 1. PP(4)→RI(2) {N} 2. PP(4)→SD(1)→RI(2) {Y} 3. PP(4)→ES(3)→RI(2) {N} 4. PP(4)→ES(3)→SD(1)→RI(2) {Y} | - |
Common adoption paths (attending physicians, medical residents, and PGYs) | - | 2. PP→SD→RI 4. PP→ES→SD→RI | Common suited adoption paths |
- |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Yu, S.-F.; Hsu, C.-M.; Wang, H.-T.; Cheng, T.-T.; Chen, J.-F.; Lin, C.-L.; Yu, H.-T. Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach. Healthcare 2022, 10, 1844. https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10101844
Yu S-F, Hsu C-M, Wang H-T, Cheng T-T, Chen J-F, Lin C-L, Yu H-T. Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach. Healthcare. 2022; 10(10):1844. https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10101844
Chicago/Turabian StyleYu, Shan-Fu, Chih-Ming Hsu, Hui-Ting Wang, Tien-Tsai Cheng, Jia-Feng Chen, Chia-Li Lin, and Hsing-Tse Yu. 2022. "Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach" Healthcare 10, no. 10: 1844. https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10101844