Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool

Background Shared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this. Objective The objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design. Methods We employed a multistep design process drawing on patient and expert involvement. Results A virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience. Conclusions It is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity.

[1]  Dave Davis,et al.  Selecting educational interventions for knowledge translation , 2010, Canadian Medical Association Journal.

[2]  J. Bensing,et al.  Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. , 2000, Patient education and counseling.

[3]  A. Wolff,et al.  Older Adults’ Views and Communication Preferences About Cancer Screening Cessation , 2017, JAMA internal medicine.

[4]  T. Greenhalgh,et al.  Evidence based medicine: a movement in crisis? , 2014, BMJ : British Medical Journal.

[5]  S. Gillard,et al.  Teaching and assessment of explanation and planning in medical schools in the United Kingdom: Cross sectional questionnaire survey , 2009, Medical teacher.

[6]  R. Thomson,et al.  Implementing shared decision making in the NHS: lessons from the MAGIC programme , 2017, British Medical Journal.

[7]  Alexander A Kon,et al.  The shared decision-making continuum. , 2010, JAMA.

[8]  N. Maskrey,et al.  Shared Understanding With Patients , 2017, JAMA internal medicine.

[9]  Marc N. Elliott,et al.  Reducing Patients’ Unmet Concerns in Primary Care: the Difference One Word Can Make , 2007, Journal of General Internal Medicine.

[10]  W. Lam,et al.  Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? , 2014, Patient education and counseling.

[11]  J. Braithwaite,et al.  Shared decision-making: the perspectives of young adults with type 1 diabetes mellitus , 2014, Patient preference and adherence.

[12]  N. Freemantle,et al.  Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? , 1999, JAMA.

[13]  T. Hoffmann,et al.  Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. , 2015, The Cochrane database of systematic reviews.

[14]  M. Ingham,et al.  Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs , 2017, Patient preference and adherence.

[15]  Paul Hong,et al.  Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret , 2016, The Laryngoscope.

[16]  Johan Creutzfeldt,et al.  Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students’ Experiences Using a Multiplayer Virtual World , 2016, JMIR serious games.

[17]  S. Staniszewska,et al.  Mapping the impact of patient and public involvement on health and social care research: a systematic review , 2014, Health expectations : an international journal of public participation in health care and health policy.

[18]  A. Schoenthaler,et al.  Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study , 2017, JMIR medical education.

[19]  Bernadette O'Neill,et al.  Enriching clinical communication teaching : a qualitative study of a curriculum field in UK medical schools , 2016 .

[20]  D. Kolb,et al.  Learning Styles and Learning Spaces: Enhancing Experiential Learning in Higher Education , 2005 .

[21]  Robert J. Crutcher,et al.  The role of deliberate practice in the acquisition of expert performance. , 1993 .

[22]  Jason J Zigmont,et al.  Theoretical foundations of learning through simulation. , 2011, Seminars in perinatology.

[23]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[24]  Jill Thistlethwaite,et al.  Active patient involvement in the education of health professionals , 2010, Medical education.

[25]  A. Coulter,et al.  Montgomery v Lanarkshire Health Board: transforming informed consent , 2017 .

[26]  Michael Fordis,et al.  Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. , 2006, JAMA.

[27]  J Flower,et al.  In the mush. , 1999, Physician executive.

[28]  C. Charles,et al.  Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). , 1997, Social science & medicine.

[29]  I. Heath The missing person: The outcome of the rule-based totalitarianism of too much contemporary healthcare. , 2017, Patient education and counseling.

[30]  F. Légaré,et al.  Twelve myths about shared decision making. , 2014, Patient education and counseling.