Assessment instruments in shared decision-making in medical courses: an integrative review

Abstract: Introduction: Shared decision making (SDM) is an approach in which doctors and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options in order to obtain informed preferences. However, as far as can be determined, the principles of SDM are not routinely taught and evaluated in medical school curricula. Objective: Identify assessment instruments applied in medical schools for teaching SDM existing in the literature. Method: The research question was formulated in April 2021. The search for articles has been carried out since January 2020 on an ongoing basis and served to consolidate the guiding question. The process took place via the CAPES Journal Portal, covering the Medline, Scielo and Lilacs databases. For the controlled vocabulary bases, we used the descriptors: shared decision making, combined with medical education alone. For the keywords, we used medical school, medical student, medical educational models, educational medical assessment measures and medical curriculum. Result: The search revealed 1,524 articles and 13 articles were selected as a review corpus. Assessment instruments in patient-centered care are important tools for assessing SDM in medical school curricula, especially the patient-practitioner orientation scale (PPOS). Scales and online questionnaires are presented as alternatives for the assessment of SDM in medical schools. The OPTION scale “observing patient involvement” proved to be a very resourceful tool in the teaching of SDM. Conclusion: All 13 SDM studies applied in medical schools were shown to be somewhat effective in assessing the skills, confidence, or attitudes of undergraduate medical students. However, none of these studies performed long-term follow-up assessments. We understand that, especially in Brazil, new research must be carried out, both related to the validation of scales that prove to be internationally effective and in the construction of instruments more contextualized to our reality.

摘要：共享决策（Shared Decision Making, SDM）是指医患双方在面临决策任务时共享现有最佳证据，并支持患者考量各项选项以形成知情偏好的实践模式。然而据现有资料显示，医学院课程体系中并未常规化开展共享决策相关原则的教学与考核工作。
研究目的：梳理现有文献中应用于医学院校共享决策教学的评估工具。
研究方法：本研究的研究问题于2021年4月确立。自2020年1月起持续开展文献检索，以夯实研究核心问题的合理性。检索过程依托CAPES期刊门户完成，覆盖Medline、Scielo及Lilacs数据库。针对受控词汇库，采用“共享决策（Shared Decision Making）”与“医学教育”组合作为检索式；关键词则选取医学院校、医学生、医学教育模式、医学教育评估工具及医学课程体系。
研究结果：本次检索共获取1524篇文献，最终筛选出13篇文献作为本综述的分析语料。以患者为中心的照护评估工具是评估医学院校共享决策教学的重要工具，其中尤以医患从业者导向量表（Patient-Practitioner Orientation Scale, PPOS）应用广泛。各类量表与线上问卷均可作为医学院校共享决策教学评估的备选方案。用于观察患者参与度的OPTION量表已被证实为共享决策教学中极具实用性的评估工具。
研究结论：本次纳入的13项针对医学院校共享决策教学的评估研究均在一定程度上可有效评估本科医学生的相关技能、自信心或态度，但上述研究均未开展长期追踪评估。我们认为，尤其在巴西，亟需开展两类新研究：一是对经国际验证有效的评估量表进行本土化验证，二是构建更贴合本国实际情境的评估工具。