AN E-LEARNING MODULE FOR SHARED DECISION MAKING WITH OLDER CANCER PATIENTS: IMPROVEMENT OF ONCOLOGISTS' SELF-REPORTED COGNITIONS AND BEHAVIOR
Methods: We developed an e-learning on SDM with older cancer patients including two parts: 1) SDM theory, evidence, and its relevance in older patients, 2) five steps to promote SDM during medical encounters, presented based on a clinical case and illustrated with videos presenting poor and good examples. The e-learning takes about 80 minutes.
For this pragmatic effect evaluation with a pre-post measurement design, we invited 77 oncologists and residents. Data was collected by three online questionnaires: T1, 2 weeks before completing the e-learning, T2, right after completing the e-learning and T3, 6 weeks after completing the e-learning. Primary outcome was learning effect in terms of attitude, self-reported SDM skills, intention, performance, and knowledge. Secondary outcome was the acceptance of the e-learning in terms of informativeness, user friendliness and relevance, measured on 0-10 scales.
We used descriptive statistics for the acceptance outcomes and Wilcoxon Signed Rank tests to analyze learning effects.
Results: We included 44 oncologists (response rate: 57%), of whom 26 completed the e-learning and the three questionnaires (59%). Medians of informativeness, user-friendliness and relevancy were 7, 7, and 8, respectively. Of the respondents, 81% would recommend the e-learning to colleagues.
We found significant (P=<0.01) improvement for intention between T1 and T2 (scale range -3 - 3; Median: T1=2, T2=2.17, T3=2), performance (scale range 0-100; Median: T1=55, T2=65.5, T3=80), knowledge (scale range 1-10; Median: T1=6, T2=7, T3=6). Oncologists rated their baseline (T1) SDM skills significantly lower after completing the e-learning than at T1 (response shift). Therefore, we performed a then-test correction, which showed significant improvement of self-reported SDM skills too (scale range 1-10; Media: Then-test corrected T1=6, T2=7, T3=7.5). No change in attitude was found (scale range 0-10; Median: T1=8, T2=8, T3=8).
Conclusions: Positive results were found for all acceptance and learning outcomes, except for attitude, which might be explained by an already highly favorable attitude at baseline. With this easy accessible teaching method, improvements concerning SDM cognitions and self-perceived behavior can be reached. Further studies that include patient-level data are necessary to gain insight into whether the e-learning improves oncologists’ actual SDM behavior during medical encounters.