PS 4-3 SHARED DECISION-MAKING TRAINING TO PROMOTE EMPOWERMENT, RISK UNDERSTANDING AND QUESTION-ASKING: FINDINGS FROM A CLUSTER-RCT WITH LOWER LITERACY ADULTS

Wednesday, October 26, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 4-3

Danielle Muscat, BPsych(Hons)1, Suzanne Morony, PhD1, Heather Shepherd, PhD2, Sian Smith, PhD3, Haryana Dhillon, MA, PhD4, Lyndal Trevena, MBBS, MPhilPH, PhD1, Andrew Hayen, PhD5, Karen Luxford6, Don Nutbeam, PhD1 and Kirsten McCaffery, BSc, PhD1, (1)School of Public Health, University of Sydney, University of Sydney, Australia, (2)Psycho-oncology Co-operative Research Group, University of Sydney, University of Sydney, Australia, (3)Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia, (4)Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), University of Sydney, Australia, (5)School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia, (6)Patient-based care, Clinical Excellence Commission, Sydney, Australia
Purpose:

To evaluate a Shared Decision Making (SDM) training program for health consumers with lower literacy delivered in an adult education setting. 

Method:

We created a 6-hour SDM training program for adults with lower literacy. The program aimed to develop students’ self-efficacy and understanding of: (a) SDM concepts and terminology, (b) quantitative risks and benefits, including uncertainty about future outcomes (c) the role of values and preferences, and (d) question-asking tools to facilitate SDM (AskShareKnow questions).

The program was delivered in Australian adult education centres in 2014 (n=308) and evaluated in a 2-arm cluster-randomised controlled trial to compare SDM training (intervention) with a standard Language, Literacy and Numeracy course (control).

Outcomes assessed immediately (T1), and 6 months (T2) post-intervention included: SDM knowledge (terminology; graphical literacy; numeracy), decision-making concepts, AskShareKnow question recall and use, decision-making preferences, and decisional conflict.

Result:

Overall, 219 (71.1%) and 156 (50.6%) students completed immediate and 6-month questionnaires respectively.

At T1, all participants scored well on a purpose-designed competency-based SDM knowledge measure (no group differences). Intervention students were more likely to perceive SDM concepts important to discuss with healthcare professionals when making a decision about their health (e.g. benefits and harms; intervention: 49% vs control: 3%; p<0.001). Control students were more likely to consider procedural questions (e.g. “Where can I make an appointment?”) important to discuss (intervention: 33% vs control: 75%; p<0.001).

Of the intervention participants, 78% and 44% correctly recalled at least one AskShareKnow question at T1 and T2 respectively. Of those who had had a healthcare encounter since program completion, 42% reported asking at least one AskShareKnow question. There was no difference in decision-making preferences or decisional conflict between groups at T2 (p>.05).

Conclusion:

Brief training in SDM for adult consumers with lower literacy was successful in supporting high recall of the AskShareKnow questions with many participants reporting they had asked at least one of the questions in a subsequent healthcare consultation. 

Training can increase the perceived value SDM concepts/questions. Consumers with lower literacy considered SDM concepts (options, harms/benefits, likelihood) important for decision-making only after training; without training procedural questions were prioritized.

In the absence of validated measures to assess SDM knowledge for consumers, there is a need to develop and validate more sensitive competency-based measures.

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