Educating for supported decision making and shared decision making: a scoping review of educational design and outcomes for education and training interventions

To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making. A scoping review was performed to identify academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick’s hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis. A total of 33 articles were identified (<i>n</i> = 7 for supported decision making and <i>n</i> = 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (<i>n</i> = 14), dementia or neurocognitive disorders (<i>n</i> = 6), cognitive disability (<i>n</i> = 5), mixed populations (<i>n</i> = 1), and those receiving end-of-life care (<i>n</i> = 7). In their design, most programs sought specific changes in practice (behaviour) <i>via</i> experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour. Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design. Existing education and training programs for supported and shared decision making have a solid focus on modifying supporter behaviour through information provision, reflective practice, and modelling and coaching desired behaviour.To fully realise supported decision making, education and training programs would benefit from a focus on program co-design and working within a socio-ecological model of supported decision making.Future evaluations of supported decision making education should draw from both quantitative and qualitative approaches, with a focus on identifying the learning processes through which education influences supporter behaviour, organisational practices, and client/patient outcomes. Existing education and training programs for supported and shared decision making have a solid focus on modifying supporter behaviour through information provision, reflective practice, and modelling and coaching desired behaviour. To fully realise supported decision making, education and training programs would benefit from a focus on program co-design and working within a socio-ecological model of supported decision making. Future evaluations of supported decision making education should draw from both quantitative and qualitative approaches, with a focus on identifying the learning processes through which education influences supporter behaviour, organisational practices, and client/patient outcomes.

本研究旨在系统梳理现有关于辅助决策（supported decision making）与共同决策（shared decision making）教育培训项目的设计及学习成果的相关知识。本次研究采用范围综述（scoping review）方法，检索2006年1月至2022年2月期间发表的学术文献与灰色文献，筛选出涉及辅助决策或共同决策教育培训项目的设计及/或学习成果的相关研究。纳入研究的文献按照教育设计领域及柯克帕特里克学习效果层级模型（Kirkpatrick’s hierarchy of learning effectiveness）进行分类，并通过跨案例分析开展定性综合。最终共纳入33篇文献：其中辅助决策相关文献n=7，共同决策相关文献n=26。这些研究均为精神疾病/物质使用障碍患者（n=14）、痴呆或神经认知障碍患者（n=6）、认知障碍患者（n=5）、混合人群（n=1）及临终关怀接受者（n=7）的支持者提供了教育或培训。从项目设计来看，绝大多数项目通过体验式学习（experiential learning），期望推动实践者行为发生特定转变。现有研究报告的教育成果亦聚焦于支持者的行为改变，但关于学习者的态度、技能或知识变化如何推动支持者行为改变的相关证据较为匮乏。未来的教育培训项目可进一步融入教学理论与学习理论，尤其是面向协同设计的相关理论，以提升项目质量。当前面向辅助决策与共同决策的教育培训项目，主要通过信息供给、反思性实践（reflective practice）、行为示范与辅导来推动支持者的行为改变，这一导向十分明确。若要充分实现辅助决策的目标，教育培训项目应聚焦于项目协同设计，并依托辅助决策的社会生态模型（socio-ecological model）开展实践。未来针对辅助决策教育的评估研究，应兼顾定量与定性研究方法，重点厘清教育通过何种学习过程影响支持者行为、组织实践以及服务对象/患者的结局。当前面向辅助决策与共同决策的教育培训项目，主要通过信息供给、反思性实践、行为示范与辅导来推动支持者的行为改变，这一导向十分明确。若要充分实现辅助决策的目标，教育培训项目应聚焦于项目协同设计，并依托辅助决策的社会生态模型开展实践。未来针对辅助决策教育的评估研究，应兼顾定量与定性研究方法，重点厘清教育通过何种学习过程影响支持者行为、组织实践以及服务对象/患者的结局。