SHARE Approach Evaluation

Study Overview
=================
Brief Summary
-----------------
The SHARE Approach Evaluation study was meant to evaluate the SHARE Approach, designed by AHRQ and UCD. The SHARE Approach is a training program for clinicians on shared decision making.

Detailed Description
-----------------
This research group has been selected by the Agency for Healthcare Research and Quality (AHRQ) to evaluate its SHARE Approach Model. This model is designed to improve shared-decision making (SDM) between providers and patients, and teaches clinicians skills that are applicable to SDM in the context of preference-sensitive treatment choice and problem-solving. It remains one of the only freely available SDM toolkits that provides clinician-facing resources for comprehensive SDM training. This study will assess the effectiveness of the SHARE model training using training evaluation surveys, card survey data with providers who have received the SHARE training, and their patients, and audio recordings of clinician/patient encounters. The training and evaluations will be done at a total of 12 health care practices (10 primary care practices and 2 cardiology practices). All research data will be de-identified and kept confidential.

Official Title
-----------------
SHARE Approach Evaluation

Conditions
-----------------
Shared Decision Making

Intervention / Treatment
-----------------
* Behavioral: SHARE Approach


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Population to be enrolled include clinicians and any practice staff who participate in the SHARE Approach training in 12 practices to be recruited across Colorado. Patients will also be enrolled for the card surveys and audio recordings if they are meeting with a clinician who has taken the SHARE Approach training. 18 to 89 years old Exclusion Criteria: Children Decisionally challenged Prisoners

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 89 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Primary Care Practice<br>We recruited 10 primary care practices from across Colorado, from all regions of the state (e.g., Eastern Plains, Mountain West, Front Range), and a mix of rural and urban practices of varying sizes. We recruited both practice staff and patients for this cohort. | Behavioral: SHARE Approach<br>* The SHARE Approach training was given at each of these centers, teaching skills to clinicians about shared decision making.<br>|
| Cardiology Practice<br>We recruited 2 cardiology practices from across Colorado, from all regions of the state (e.g., Eastern Plains, Mountain West, Front Range), and a mix of rural and urban practices of varying sizes. We recruited both practice staff and patients for this cohort. | Behavioral: SHARE Approach<br>* The SHARE Approach training was given at each of these centers, teaching skills to clinicians about shared decision making.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Usefulness of the SHARE Approach training | Usefulness of the SHARE approach training will be measured using a training evaluation survey question that asks participants how useful they found the SHARE approach. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 1 day post-training | 
| Usefulness of the SHARE Approach training | Usefulness of the SHARE approach training will be measured using a training evaluation survey question that asks participants how useful they found the SHARE approach. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | 2 months post-training | 
| Ability to engage in shared decision making | Engagement of Shared Decision Making from the SHARE approach training will be measured using a training evaluation survey question that asks participants how able they feel to engage in shared decision making after the SHARE approach training. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 1 day post-training | 
| Ability to engage in shared decision making | Engagement of Shared Decision Making from the SHARE approach training will be measured using a training evaluation survey question that asks participants how able they feel to engage in shared decision making after the SHARE approach training. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | 2 months post-training | 
| Overall evaluation of the SHARE Approach | Overall evaluation of the SHARE approach training will be measured using a training evaluation survey question that asks participants whether they would positively or negatively evaluate the SHARE approach. Possible scores range from 1 to 5, with lower scores indicating more negative values and higher scores indicating more positive values. | up to 1 day post-training | 
| Overall evaluation of the SHARE Approach | Overall evaluation of the SHARE approach training will be measured using a training evaluation survey question that asks participants whether they would positively or negatively evaluate the SHARE approach. Possible scores range from 1 to 5, with lower scores indicating more negative values and higher scores indicating more positive values. | 2 months post-training | 
| Confidence in doing shared decision making | Clinician confidence in doing shared decision making was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months pre-training | 
| Confidence in doing shared decision making | Clinician confidence in doing shared decision making was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | 2 months post-training | 
| Confidence in doing shared decision making | Clinician confidence in doing shared decision making was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months post-training | 
| Confidence in understanding shared decision making | Clinician confidence in understanding shared decision making was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months pre-training | 
| Confidence in understanding shared decision making | Clinician confidence in understanding shared decision making was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months post-training | 
| Clinician satisfaction with encounter | Clinician satisfaction with encounter was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months pre-training | 
| Clinician satisfaction with encounter | Clinician satisfaction with encounter was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months post-training | 
| Patient satisfaction with encounter | Patient satisfaction with encounter was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months pre-training | 
| Patient satisfaction with encounter | Patient satisfaction with encounter was measured by a brief card survey question with a 5 point Likert scale. Possible scores range from 1 to 5, with lower scores indicating less usefulness and higher scores indicating more usefulness. | up to 6 months post-training | 
| Clinician shared decision making (self-reported) | After clinician/patient encounters, clinicians were asked to fill out a brief card survey rating shared decision making that occurred during the encounter. These include questions from the Dyadic OPTION (observing patient involvement in decision making) scale. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | up to 6 months pre-training | 
| Clinician shared decision making (self-reported) | After clinician/patient encounters, clinicians were asked to fill out a brief card survey rating shared decision making that occurred during the encounter. These include questions from the Dyadic OPTION (observing patient involvement in decision making) scale. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | up to 24 hours post-training | 
| Clinician shared decision making (self-reported) | After clinician/patient encounters, clinicians were asked to fill out a brief card survey rating shared decision making that occurred during the encounter. These include questions from the Dyadic OPTION (observing patient involvement in decision making) scale. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | 2 months post-training | 
| Patient shared decision making (self-reported) | After clinician/patient encounters, patients were asked to fill out a brief card survey rating their experiences with shared decision making during the encounter. These included questions modified from the Dyadic OPTION (observing patient involvement in decision making) scale. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | up to 6 months pre-training | 
| Patient shared decision making (self-reported) | After clinician/patient encounters, patients were asked to fill out a brief card survey rating their experiences with shared decision making during the encounter. These included questions modified from the Dyadic OPTION scale. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | up to 24 hours post-training | 
| Patient shared decision making (self-reported) | After clinician/patient encounters, patients were asked to fill out a brief card survey rating their experiences with shared decision making during the encounter. These included questions modified from the Dyadic OPTION (observing patient involvement in decision making) scale. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | 2 months post-training | 
| Shared Decision Making (highest score) | A subset of clinician/patient encounters were audio recorded, and then coded using a modified OPTION (observing patient involvement in decision making) 12 coding schema for elements of shared decision making occurring within the encounter. As a primary outcome, we selected the highest-scored topic discussed in each encounter. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | At clinic visit, up to 12 months post-training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shared Decision Making (total score) | Clinician/patient encounters were audio recorded, and then coded using a modified OPTION (observing patient involvement in decision making) 12 coding schema for different elements of shared decision making within the encounter. The secondary outcome was the total score for each encounter, which averaged across scores for all topics discussed. Higher scores reflected better experiences of shared decision making, whereas lower scores reflected poorer experiences of shared decision making. | At clinic visit, up to 12 months post-training |