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Teaching clinicians shared decision making and risk communication online: an evaluation study
  1. Tammy C Hoffmann1,
  2. Chris Del Mar1,
  3. Ramai Santhirapala2,
  4. Alexandra Freeman3
  1. 1Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
  2. 2Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
  1. Correspondence to Professor Tammy C Hoffmann, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia; thoffmann{at}


Objectives To describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties.

Design Comparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication.

Setting Online and open to all specialties and levels of clinical experience, including students.

Participants The course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study.

Intervention The self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK’s National Health Service e-learning platform.

Main outcome measures Pre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool; total score range 10–50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked.

Results Of 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants’ mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p<0.0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p<0.0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions.

Conclusions This online, free e-learning course was successful in increasing participants’ confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians’ numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.

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  • Contributors TCH and CDM developed the original course, which was modified for the UK audience by AF with support and national endorsement from RS. AF collected and cleaned the evaluation data, which was analysed by TH. TCH, AF and CDM drafted the manuscript. The corresponding author acts as the guarantor and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted, and that the manuscript represents an honest, accurate and transparent account of the study with no important aspects having been omitted.

  • Funding The development of the original e-learning course was funded by the Australian Commission on Safety and Quality in Health CareHealthcare and is used under license by the Academy of Medical Royal Colleges. The adaptations for the UK and different specialties was funded by the Winton Centre for Risk and Evidence Communication at the University of Cambridge, which is itself funded by a donation from the David & Claudia Harding Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This evaluation study was reviewed by the Psychology Research Ethics Committee at the University of Cambridge and granted approval (PRE.2018.034).

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

  • Data availability statement Data are available in a public, open access repository. Anonymised data will be uploaded to an Open Science Framework repository on acceptance.

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