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Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies
  1. Evamaria Müller1,
  2. Alena Strukava1,
  3. Isabelle Scholl1,
  4. Martin Härter1,
  5. Ndeye Thiab Diouf2,
  6. France Légaré2,
  7. Angela Buchholz1
  1. 1 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
  1. Correspondence to Evamaria Müller; e.mueller{at}


Design and objectives We performed a systematic review of studies evaluating healthcare provider (HCP) trainings in shared decision-making (SDM) to analyse their evaluation strategies.

Setting and participants HCP trainings in SDM from all healthcare settings.

Methods We searched scientific databases (Medline, PsycInfo, CINAHL), performed reference and citation tracking, contacted experts in the field and scanned the Canadian inventory of SDM training programmes for healthcare professionals. We included articles reporting data of summative evaluations of HCP trainings in SDM. Two reviewers screened records, assessed full-text articles, performed data extraction and assessed study quality with the integrated quality criteria for review of multiple study designs (ICROMS) tool. Analysis of evaluation strategies included data source use, use of unpublished or published measures and coverage of Kirkpatrick’s evaluation levels. An evaluation framework based on Kirkpatrick’s evaluation levels and the Quadruple Aim framework was used to categorise identified evaluation outcomes.

Results Out of 7234 records, we included 41 articles reporting on 30 studies: cluster-randomised (n=8) and randomised (n=9) controlled trials, controlled (n=1) and non-controlled (n=7) before-after studies, mixed-methods (n=1), qualitative (n=1) and post-test (n=3) studies. Most studies were conducted in the USA (n=9), Germany (n=8) or Canada (n=7) and evaluated physician trainings (n=25). Eleven articles met ICROMS quality criteria. Almost all studies (n=27) employed HCP-reported outcomes for training evaluation and most (n=19) additionally used patient-reported (n=12), observer-rated (n=10), standardised patient-reported (n=2) outcomes or training process and healthcare data (n=10). Most studies employed a mix of unpublished and published measures (n=17) and covered two (n=12) or three (n=10) Kirkpatrick’s levels. Identified evaluation outcomes covered all categories of the proposed framework.

Conclusions Strategies to evaluate HCP trainings in SDM varied largely. The proposed evaluation framework maybe useful to structure future evaluation studies, but international agreement on a core set of outcomes is needed to improve evidence.

PROSPERO registration number CRD42016041623.

  • decision making
  • review [publication type]
  • education [subheading]
  • professional-patient relations
  • outcome assessment (health care)

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  • Contributors EM, IS, MH and AB conceived and planned the study. EM developed and conducted the electronic database search strategy. EM and NTD performed the secondary search strategy. EM and AS screened records. EM, AS and NTD screened full-text articles. EM and AS performed data extraction and quality assessment of included articles. EM, IS, MH, FL, NTD and AB contributed to the analysis and interpretation of study results and to the development of the evaluation framework for healthcare provider trainings in SDM. EM, AS, IS, MH, FL, NTD and AB contributed to the writing of the manuscript and approved submission.

  • Funding This work was partly funded by Mundipharma GmbH, a pharmaceutical company.

  • Disclaimer Mundipharma GmbH had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests EM and AS report grants from Mundipharma GmbH during the conduct of the study. EM, AS, IS, MH and AB conducted SDM communication skills trainings in a project funded by Mundipharma GmbH. NTD and FL have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extracted data can be obtained from the corresponding author.

  • Patient consent for publication None.

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